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.

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.

Lateral sesamoid position in hallux valgus: correlation with the conventional radiological assessment.

PubMed

Agrawal, Yuvraj; Desai, Aravind; Mehta, Jaysheel

2011-12-01

We aimed to quantify the severity of the hallux valgus based on the lateral sesamoid position and to establish a correlation of our simple assessment method with the conventional radiological assessments. We reviewed one hundred and twenty two dorso-plantar weight bearing radiographs of feet. The intermetatarsal and hallux valgus angles were measured by the conventional methods; and the position of lateral sesamoid in relation to first metatarsal neck was assessed by our new and simple method. Significant correlation was noted between intermetatarsal angle and lateral sesamoid position (Rho 0.74, p < 0.0001); lateral sesamoid position and hallux valgus angle (Rho 0.56, p < 0.0001). Similar trends were noted in different grades of severity of hallux valgus in all the three methods of assessment. Our method of assessing hallux valgus deformity based on the lateral sesamoid position is simple, less time consuming and has statistically significant correlation with that of the established conventional radiological measurements. Copyright © 2011 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

New modified technique of osteotomy for hallux valgus.

PubMed

Oh, I S; Kim, M K; Lee, S H

2004-12-01

To improve the technique of osteotomy for hallux valgus (bunion). 38 cases of a new modified osteotomy procedure for hallux valgus were performed for 22 patients (21 women and one man). During a 3-year (range, 2-5 years) follow-up, the patients underwent physical examination; and their American Orthopedic Foot and Ankle Society hallux-metatarso-phalangeal-interphalangeal scale scores and standard foot radiographic measurements were recorded. 20 of the 22 patients (38 cases) had no pain, achieved good cosmesis, and were completely satisfied with the results of the operation. The remaining 2 patients had occasional mild discomfort. The mean hallux-metatarso-phalangeal-interphalangeal scale score was 93 points (range, 78-100 points). The mean preoperative and postoperative metatarsophalangeal angles were 34 degrees and 11 degrees, respectively. The mean postoperative reduction of the intermetatarsal angle and metatarsophalangeal angle were 6 degrees and 23 degrees, respectively. The new technique of osteotomy achieved even greater stability and accurate correction of the deformity in our 38 cases. Furthermore, it was more effective than conventional 'chevron' osteotomy in terms of correction of the deformity. Therefore, it should be used more widely.

[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

[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.

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.

[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.

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

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

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

The hallux valgus angle of the margo medialis pedis as an alternative to the measurement of the metatarsophalangeal hallux valgus angle.

PubMed

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

2014-04-21

Currently, the metatarsophalangeal angle (hallux valgus angle) is measured based on radiographic images. However, using X-ray examinations for epidemiological or screening purposes would be unethical, especially in children. For this reason it is discussed to measure the hallux valgus angle of the margo medialis pedis (medial border of the foot) documented on foot outline drawings or foot scans. As a first step on the way to prove the validity of those approaches this study assesses the hallux valgus angle measured on the margo medialis pedis based on the same x-ray pictures as the metatarsophalangeal hallux valgus. Radiographic images of the foot were obtained from patients with symptomatic hallux valgus malformation. Twelve sets of contact copies of the 63 originals were made, and were marked and measured according to three different methods, each one performed by two observers and with two repeated measurements. Thus, data sets from 756 individual assessments were entered into the multifactorial statistical analysis.Comparisons were made between the angle of the margo medialis pedis and the metatarsophalangeal angle, which was determined by two different methods. To determine the inter- and intraobserver reliability of the different methods, each assessment was conducted by two independent experts and repeated after a period of several weeks. The correlations between the hallux valgus angles determined by the three different methods were all above r=0.89 (p<0.001) and thus highly significant. The values obtained by measuring the margo medialis pedis angle, however, were on average 4.8 degrees smaller than the metatarsophalangeal angles. No significant differences were found between the observers. No systematic deviations for any observer between repeated measurements were detected. Measurements of the radiographic hallux angle of the margo medialis pedis are reliable and show high correlation with the metatarsophalangeal angle. Because the hallux valgus angles

The hallux valgus angle of the margo medialis pedis as an alternative to the measurement of the metatarsophalangeal hallux valgus angle

PubMed Central

2014-01-01

Background Currently, the metatarsophalangeal angle (hallux valgus angle) is measured based on radiographic images. However, using X-ray examinations for epidemiological or screening purposes would be unethical, especially in children. For this reason it is discussed to measure the hallux valgus angle of the margo medialis pedis (medial border of the foot) documented on foot outline drawings or foot scans. As a first step on the way to prove the validity of those approaches this study assesses the hallux valgus angle measured on the margo medialis pedis based on the same x-ray pictures as the metatarsophalangeal hallux valgus. Methods Radiographic images of the foot were obtained from patients with symptomatic hallux valgus malformation. Twelve sets of contact copies of the 63 originals were made, and were marked and measured according to three different methods, each one performed by two observers and with two repeated measurements. Thus, data sets from 756 individual assessments were entered into the multifactorial statistical analysis. Comparisons were made between the angle of the margo medialis pedis and the metatarsophalangeal angle, which was determined by two different methods. To determine the inter- and intraobserver reliability of the different methods, each assessment was conducted by two independent experts and repeated after a period of several weeks. Results The correlations between the hallux valgus angles determined by the three different methods were all above r = 0.89 (p < 0.001) and thus highly significant. The values obtained by measuring the margo medialis pedis angle, however, were on average 4.8 degrees smaller than the metatarsophalangeal angles. No significant differences were found between the observers. No systematic deviations for any observer between repeated measurements were detected. Conclusions Measurements of the radiographic hallux angle of the margo medialis pedis are reliable and show high correlation with the

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.

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.

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.

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.

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.

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.

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.

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

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.

Radiographic angles in hallux valgus: Comparison between protractor and iPhone measurements.

PubMed

Meng, Hong-Zheng; Zhang, Wei-Lin; Li, Xiu-Cheng; Yang, Mao-Wei

2015-08-01

Radiographic angles are used to assess the severity of hallux valgus deformity, make preoperative plans, evaluate outcomes after surgery, and compare results between different methods. Traditionally, hallux valgus angle (HVA) has been measured by using a protractor and a marker pen with hardcopy radiographs. The main objective of this study is to compare HVA measurements performed using a smartphone and a traditional protractor. The secondary objective was to compare the time taken between those two methods. Six observers measured major HVA on 20 radiographs of hallux valgus deformity with both a standard protractor and an Apple iPhone. Four of the observers repeated the measurements at least a week after the original measurements. The mean absolute difference between pairs of protractor and smartphone measurements was 3.2°. The 95% confidence intervals for intra-observer variability were ±3.1° for the smartphone measurement and ±3.2° for the protractor method. The 95% confidence intervals for inter-observer variability were ±9.1° for the smartphone measurement and ±9.6° for the protractor measurement. We conclude that the smartphone is equivalent to the protractor for the accuracy of HVA measurement. But, the time taken in smartphone measurement was also reduced. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

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.

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.

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

[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.

Reliability of Two Smartphone Applications for Radiographic Measurements of Hallux Valgus Angles.

PubMed

Mattos E Dinato, Mauro Cesar; Freitas, Marcio de Faria; Milano, Cristiano; Valloto, Elcio; Ninomiya, André Felipe; Pagnano, Rodrigo Gonçalves

The objective of the present study was to assess the reliability of 2 smartphone applications compared with the traditional goniometer technique for measurement of radiographic angles in hallux valgus and the time required for analysis with the different methods. The radiographs of 31 patients (52 feet) with a diagnosis of hallux valgus were analyzed. Four observers, 2 with >10 years' experience in foot and ankle surgery and 2 in-training surgeons, measured the hallux valgus angle and intermetatarsal angle using a manual goniometer technique and 2 smartphone applications (Hallux Angles and iPinPoint). The interobserver and intermethod reliability were estimated using intraclass correlation coefficients (ICCs), and the time required for measurement of the angles among the 3 methods was compared using the Friedman test. A very good or good interobserver reliability was found among the 4 observers measuring the hallux valgus angle and intermetatarsal angle using the goniometer (ICC 0.913 and 0.821, respectively) and iPinPoint (ICC 0.866 and 0.638, respectively). Using the Hallux Angles application, a very good interobserver reliability was found for measurements of the hallux valgus angle (ICC 0.962) and intermetatarsal angle (ICC 0.935) only among the more experienced observers. The time required for the measurements was significantly shorter for the measurements using both smartphone applications compared with the goniometer method. One smartphone application (iPinPoint) was reliable for measurements of the hallux valgus angles by either experienced or nonexperienced observers. The use of these tools might save time in the evaluation of radiographic angles in the hallux valgus. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

[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) 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.

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, 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

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.

Radiographic angles in hallux valgus: differences between measurements made manually and with a computerized program.

PubMed

Piqué-Vidal, Carlos; Maled-García, Ignaci; Arabi-Moreno, Juanjo; Vila, Joan

2006-03-01

The objective of this study was to compare angular measurements in the evaluation of hallux valgus deformities using a goniometer and a computerized program to assess degree of concordance between the two methods and determine the reliability of manual measurements. Angles measured included the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the distal metatarsal articular angle (DMAA), and the proximal phalangeal articular angle (PPAA), also called the hallux valgus interphalangeus angle or interphalangeal angle. Measurements were made on preoperative weightbearing radiographs in 176 patients with symptomatic hallux valgus. Manual measurements were made with a goniometer by an orthopaedic surgeon. An independent experienced technician used digitized images to perform angular measurements with the Autocad software program (Autodesk Inc., San Rafael, CA). HVA values obtained with the two techniques were similar. However, significantly higher mean values were obtained with the Autocad for the IMA and PPAA measurements, and higher mean values were obtained for the DMAA measurement with the manual technique. Whereas differences were more or less randomly distributed for the HVA, in the remaining patients, measurements were clearly related to the measurement technique, i.e., for the DMAA, the manual technique had a tendency to show higher values, and for the IMA and PPAA the manual technique showed lower values than the computer. Correlations between both techniques for the different angular measurements were as follows: HVA, -0.179 (p = 0.018); DMMA, -0.294 (p < 0.001); PPAA, -0.876 (p < 0.001); and IMA, -0.661 (p < 0.001). The intraclass correlation coefficient (ICC) showed that the concordance between manual and Autocad angular measurements was excellent for the HVA (ICC = 0.89) and DMAA (ICC = 0.80) and very poor for the PPAA (ICC = 0.11) and IMA (ICC = 0.42). Angular measurements made on weightbearing radiographs with the Autocad in patients with hallux

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.

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.

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.

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

Radiographic Shape of Foot With Second Metatarsophalangeal Joint Dislocation Associated With Hallux Valgus.

PubMed

Kokubo, Tetsuro; Hashimoto, Takeshi; Suda, Yasunori; Waseda, Akeo; Ikezawa, Hiroko

2017-12-01

Second metatarsophalangeal (MTP) joint dislocation is associated with hallux valgus, and the treatment of complete dislocation can be difficult. The purpose of this study was to radiographically clarify the characteristic foot shape in the presence of second MTP joint dislocation. Weight-bearing foot radiographs of the 268 patients (358 feet) with hallux valgus were examined. They were divided into 2 groups: those with second MTP joint dislocation (study group = 179 feet) and those without dislocation (control group = 179 feet). Parameters measured included the hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), second MTP joint angle, hallux interphalangeal angle (IPA), second metatarsal protrusion distance (MPD), metatarsus adductus angle (MAA), and the second metatarsal declination angle (2MDA). Furthermore, the dislocation group was divided into 3 subgroups according to second toe deviation direction: group M (medial type), group N (neutral type), and group L (lateral type). The IPA and the 2MDA were significantly greater in the study group than in the control group. By multiple comparison analysis, the IMA was greatest in group M and smallest in group L. The IPA was smaller and 2MDA greater in group N than in group L. The HVA and MAA in group L were greatest, and MPD in group L was smallest. The patients with second MTP joint dislocation associated with hallux valgus had greater hallux interphalangeal joint varus and a second metatarsal more inclined than with hallux valgus alone. The second toe deviated in a different direction according to the foot shape. Level III, retrospective comparative study.

[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.

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

[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.

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).

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 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.

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.

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.

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.

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.

Interventions for treating hallux valgus (abductovalgus) and bunions.

PubMed

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

2004-01-01

Hallux valgus is classified as an abnormal deviation of the great toe (hallux) towards the midline of the foot. To identify and evaluate the evidence from randomised trials of interventions used to correct hallux valgus. We searched the Cochrane Musculoskeletal Injuries Group trials register (2003/1), the Cochrane Central Register of Controlled Trials (The Cochrane Library issue 1, 2003), MEDLINE (January 1966 to March 2003) and EMBASE (1980 to January 2003). No language restrictions were applied. Hand searching of specific foot journals was also undertaken. Date of the most recent search: 31st March 2003. Randomised or quasi-randomised trials of both conservative and surgical treatments of hallux valgus. Excluded were studies comparing areas of surgery not specific to the control of the deformity such as use of anaesthetics or tourniquet placement. Methodological quality of trials which met the inclusion criteria was independently assessed by two reviewers. Data extraction was undertaken by two reviewers. The trials were grouped according to the interventions being compared, but the dissimilarity in the comparisons prevented pooling of results. The methodological quality of the 21 included trials was generally poor and trial sizes were small. Three trials involving 332 participants evaluated conservative treatments versus no treatment. There was no evidence of a difference in outcomes between treatment and no treatment. One good quality trial involving 140 participants compared surgery to conservative treatment. Evidence was shown of an improvement in all outcomes in patients receiving chevron osteotomy compared with those receiving orthoses. The same trial also compared surgery to no treatment in 140 participants. Evidence was shown of an improvement in all outcomes in patients receiving chevron osteotomy compared with those receiving no treatment. Two trials involving 133 people with hallux valgus compared Keller's arthroplasty with other surgical techniques. In

Is Double Metatarsal Osteotomy Superior to Proximal Chevron Osteotomy in Treatment of Hallux Valgus With Increased Distal Metatarsal Articular Angle?

PubMed

Park, Chul Hyun; Lee, Woo-Chun

We compared the results of proximal chevron osteotomy and double metatarsal osteotomy for hallux valgus with an increased distal metatarsal articular angle (DMAA). From October 2008 to December 2012, first metatarsal osteotomies were performed in 64 patients (69 feet) with symptomatic hallux valgus associated with an increased DMAA. Proximal chevron with Akin osteotomy and lateral soft tissue release was performed in 46 feet (PCO group); double metatarsal osteotomy and Akin osteotomy without lateral soft tissue release was performed in 23 feet (DMO group). Clinical assessments were performed using the American Orthopaedic Foot and Ankle Society (AOFAS) scale and visual analog scale (VAS). The hallux valgus angles, intermetatarsal angles, sesamoid positions, metatarsus adductus angles, and DMAAs were compared at different postoperative times. Postoperative shortening of first the metatarsal and complications were compared. The mean AOFAS scale and VAS scores showed significant improvement in both groups after surgery; however, no significant difference was observed between the 2 groups. The immediate postoperative hallux valgus angle and sesamoid position were significantly larger in DMO group; however, no intergroup difference was observed at the last follow-up visit, with the hallux valgus angle gradually increasing in the PCO group. The postoperative DMAA was significantly smaller in the DMO group. The mean shortening of the first metatarsal after surgery was significantly larger in the DMO group than in the PCO group. Transfer metatarsalgia developed in 1 foot (2.2%) in the PCO group and 2 feet (8.7%) in the DMO group. Partial avascular necrosis of the metatarsal head with advanced arthritis of the first metatarsophalangeal joint developed in 1 foot (4.3%) in the DMO group. In conclusion, no differences in the clinical and radiographic results were observed between the 2 groups for hallux valgus deformity with an increased DMAA. Copyright © 2017 The American

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.

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.

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.

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

PubMed

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

2009-04-15

Hallux valgus is classified as an abnormal deviation of the great toe (hallux) towards the midline of the foot. To identify and evaluate the evidence from randomised trials of interventions used to correct hallux valgus. We searched the Cochrane Bone, Joint and Muscle Trauama Group trials register (2003/1), the Cochrane Central Register of Controlled Trials (The Cochrane Library issue 1, 2003), MEDLINE (January 1966 to March 2003) and EMBASE (1980 to January 2003). No language restrictions were applied. Hand searching of specific foot journals was also undertaken.Date of the most recent search: 31st March 2003. Randomised or quasi-randomised trials of both conservative and surgical treatments of hallux valgus. Excluded were studies comparing areas of surgery not specific to the control of the deformity such as use of anaesthetics or tourniquet placement. Methodological quality of trials which met the inclusion criteria was independently assessed by two reviewers. Data extraction was undertaken by two reviewers. The trials were grouped according to the interventions being compared, but the dissimilarity in the comparisons prevented pooling of results. The methodological quality of the 21 included trials was generally poor and trial sizes were small.Three trials involving 332 participants evaluated conservative treatments versus no treatment. There was no evidence of a difference in outcomes between treatment and no treatment.One good quality trial involving 140 participants compared surgery to conservative treatment. Evidence was shown of an improvement in all outcomes in patients receiving chevron osteotomy compared with those receiving orthoses. The same trial also compared surgery to no treatment in 140 participants. Evidence was shown of an improvement in all outcomes in patients receiving chevron osteotomy compared with those receiving no treatment.Two trials involving 133 people with hallux valgus compared Keller's arthroplasty with other surgical techniques

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.

[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.

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

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.

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

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

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.

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

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

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.

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.

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.

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

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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

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.

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

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.

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.

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

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.

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.

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

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

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 �

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.

[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

[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.

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.

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

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

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.

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.

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.

[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.

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.

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.

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

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.

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.

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

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.

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

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.

[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.

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.

[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

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.

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.

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.

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.

[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

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.

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.

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

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.

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.

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

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.

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.

[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

[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.

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.

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

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

[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.

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.

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.

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.

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

[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

[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.

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.

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/.

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.

Outcome of Joint-Preserving Arthroplasty for Rheumatoid Forefoot Deformities.

PubMed

Fukushi, Jun-ichi; Nakashima, Yasuharu; Okazaki, Ken; Yamada, Hisakata; Mawatari, Taro; Ohishi, Masanobu; Oyamada, Akiko; Akasaki, Yukio; Iwamoto, Yukihide

2016-03-01

Along with the recent advances in the pharmacological management of rheumatoid arthritis, there is a trend toward the use of joint-preserving surgery in the treatment of rheumatoid forefoot deformities. However, the clinical outcomes of joint-preserving surgery for rheumatoid forefoot deformities have not been assessed in comparison to resection arthroplasty. We retrospectively evaluated 23 feet in 17 patients with rheumatoid forefoot deformities who underwent surgery between January 2010 and December 2013. The patients included 1 male (1 foot) and 16 females (22 feet), with a mean age of 62 years. The mean length of follow-up was 28 months. The patients were treated by 3 surgeons. One surgeon performed joint-preserving procedures (JP group) to the feet in which (1) no pain with motion existed, and (2) the range of motion in the first metatarsophalangeal (MTP) joint was greater than 30 degrees (n = 10); otherwise, resection arthroplasty with arthrodesis of the first MTP joint was performed (n = 3). The other surgeons performed resection arthroplasty in all cases (n = 10) (RA group, n = 13 in total). The clinical outcomes of the patients were evaluated using the Japanese Society for Surgery of the Foot (JSSF) hallux and lesser toe scales. There were no significant differences in the preoperative total JSSF scores for either the hallux (54.5 and 61.4 points) or the lesser toe (45.2 and 57.4 points) between the RA and JP groups, respectively. Postoperatively, the total JSSF scores for both the hallux (79.4 and 88.2 points) and lesser toes (73.6 and 87.7 points) showed significant improvement in both the RA and JP groups, respectively; however, the JP group showed a greater postoperative improvement. The scores relating to the function category on the hallux scale and the alignment category on the lesser toe scale were significantly higher in the JP group. With regard to the function of the hallux and the alignment of the lesser toes, the joint-preserving procedures

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 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

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.

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

PubMed

Dygrýnová, M; Uvízl, M; Gallo, J

2017-01-01

osteoarthritis in order to extend the period of clinically acceptable results and thereby to postpone the TJR indication. TJR (similarly to arthrodesis of the first metatarsophalangeal joint) is a procedure performed in elderly patients with low physical activity and more advanced deformities. CONCLUSIONS Both the reported methods offer reliable and valuable short-term clinical outcomes with relatively low complication rate. Cheilectomy is undoubtedly more appropriate for younger patients with mild or moderate arthritic changes. Although it does not appear to alter the natural progression of the disease process, it provides satisfactory pain relief, motion improvement and overall patient gait comfort for patients in a short-term period. TJR seems to be a better solution for less active older patients to whom it provides a loadable, painless, and moving joint. Key words: hallux rigidus, first metatarsophalangeal joint, cheilectomy, arthroplasty, Metis®, surgical treatment.

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.

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

Bunions (Hallux Abducto Valgus)

MedlinePlus

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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.

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.

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.

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.

Does low-constraint mobile bearing knee prosthesis give satisfactory results for severe coronal deformities? A five to twelve year follow up study.

PubMed

Czekaj, Jaroslaw; Fary, Camdon; Gaillard, Thierry; Lustig, Sebastien

2017-07-01

Severe varus and valgus knee deformities traditionally are replaced with constrained implants, with a number of disadvantages. We present our results in this challenging group using a low constraint deep-dish mobile bearing implant design. One hundred fifty-four patients (170 arthroplasties) who underwent primary TKA using a deep-dish, mobile bearing posterior-stabilized implant for severe varus (HKA < 170°) or valgus (HKA > 190°) deformity between 2004 and 2009 were evaluated at a mean of 6.6 years post-operatively (minimum of 5 years). Alignment improved from a pre-operative mean (±SD) varus deformity of 167.4° (±2.6°) and a mean (±SD) valgus deformity of 194.1° (±4.0°) to an overall mean (±SD) post-operative mechanical alignment of 178.6° (±3.2°). Twenty-three patients had post-operative varus alignment, five patients had post-operative valgus alignment and 134 knees were in neutral alignment (within 3° spread). Clinical scores at final follow-up were excellent (IKS score 93.8 (±7.4) and function score 82.4 (±20.2)). Three patients were re-operated upon: one deep infection, one periprosthetic fracture and one revision at 144 months for aseptic loosening of the femoral component. No patient was revised for instability or implant failure. The survival rate at five years was 99.4% and at ten years 98.6%. Satisfactory outcomes can be achieved in patients with substantial varus or valgus deformities using low constraint deep-dish mobile bearing implant, standard approach and appropriate soft tissue releases.

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.

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.

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.

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.

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.

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

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.

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

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.

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

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.

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.

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.

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

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.

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 "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.

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 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

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 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.

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

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.

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.

[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

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.

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.

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.

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.

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.

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.

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.

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

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.

Unexpected angular or rotational deformity after corrective osteotomy

PubMed Central

2014-01-01

Background Codman’s paradox reveals a misunderstanding of geometry in orthopedic practice. Physicians often encounter situations that cannot be understood intuitively during orthopedic interventions such as corrective osteotomy. Occasionally, unexpected angular or rotational deformity occurs during surgery. This study aimed to draw the attention of orthopedic surgeons toward the concepts of orientation and rotation and demonstrate the potential for unexpected deformity after orthopedic interventions. This study focused on three situations: shoulder arthrodesis, femoral varization derotational osteotomy, and femoral derotation osteotomy. Methods First, a shoulder model was generated to calculate unexpected rotational deformity to demonstrate Codman’s paradox. Second, femoral varization derotational osteotomy was simulated using a cylinder model. Third, a reconstructed femoral model was used to calculate unexpected angular or rotational deformity during femoral derotation osteotomy. Results Unexpected external rotation was found after forward elevation and abduction of the shoulder joint. In the varization and derotation model, closed-wedge osteotomy and additional derotation resulted in an unexpected extension and valgus deformity, namely, under-correction of coxa valga. After femoral derotational osteotomy, varization and extension of the distal fragment occurred, although the extension was negligible. Conclusions Surgeons should be aware of unexpected angular deformity after surgical procedure involving bony areas. The degree of deformity differs depending on the context of the surgical procedure. However, this study reveals that notable deformities can be expected during orthopedic procedures such as femoral varization derotational osteotomy. PMID:24886469

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.

[Application of tibial mechanical axis locator in tibial extra-articular deformity in total knee arthroplasty].

PubMed

Li, Guoliang; Han, Guangpu; Zhang, Jinxiu; Ma, Shiqiang; Guo, Donghui; Yuan, Fulu; Qi, Bingbing; Shen, Runbin

2013-07-01

To explore the application value of self-made tibial mechanical axis locator in tibial extra-articular deformity in total knee arthroplasty (TKA) for improving the lower extremity force line. Between January and August 2012, 13 cases (21 knees) of osteoarthritis with tibial extra-articular deformity were treated, including 5 males (8 knees) and 8 females (13 knees) with an average age of 66.5 years (range, 58-78 years). The disease duration was 2-5 years (mean, 3.5 years). The knee society score (KSS) was 45.5 +/- 15.5. Extra-articular deformities included 1 case of knee valgus (2 knees) and 12 cases of knee varus (19 knees). Preoperative full-length X-ray films of lower extremities showed 10-21 degrees valgus or varus deformity of tibial extra joint. Self-made tibial mechanical axis locator was used to determine and mark coronal tibial mechanical axis under X-ray before TKA, and then osteotomy was performed with extramedullary positioning device according to the mechanical axis marker.' All incisions healed by first intention, without related complications of infection and joint instability. All patients were followed up 5-12 months (mean, 8.3 months). The X-ray examination showed < 2 degrees knee deviation angle in the others except 1 case of 2.9 degrees knee deviation angle at 3 days after operation, and the accurate rate was 95.2%. No loosening or instability of prosthesis occurred during follow-up. KSS score was 85.5 +/- 15.0 at last follow-up, showing significant difference when compared with preoperative score (t=12.82, P=0.00). The seft-made tibial mechanical axis locator can improve the accurate rate of the lower extremity force line in TKA for tibia extra-articular deformity.

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.

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.

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.

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.

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

Management of Cubitus Varus Deformity in Children by Closed Dome Osteotomy

PubMed Central

Kejariwal, Ujjwal; Singh, Bijendra

2017-01-01

Introduction Supracondylar fractures are the most common elbow injuries in skeletally immature children between 5-10 years of age and cubitus varus deformity is the most common late complication. Cubitus varus or bow elbow or gunstock deformity is the result of malunion occurring as a complication of supracondylar fracture of the humerus. Various type of corrective osteotomies are used of which lateral closed wedge French osteotomy is commomly used which has its own complications like lateral condylar prominence, unsightful scar and limitation of movement. Closed dome osteotomy is a technique which overcomes these complications. This surgery is done with simple readily available instruments in the orthopaedic operation theatre with no special requirements for instrumentation. Aim This study was done to study the results of closed dome osteotomy for correction of cubitus varus deformity, after malunited supracondylar fracture of humerus in children. Materials and Methods This study included 25 children of either sex with malunited supracondylar fracture of distal humerus having cubitus varus deformity admitted in orthopaedics department. After appropriate pre operative assessment, closed dome osteotomy was done and post operatively X-ray of patients was taken and carrying angle and Lateral Condylar Prominence Index (LCPI) were calculated. Patients were re-assessed at complete union and results were calculated as per Mitchell and Adams criteria. Results In our study of 25 patients, 68% were males, 32% were females. Majority (84%) of patients were in the age group of 5-10 years. Carrying angle post operatively was 0-10° valgus in 64% of patients while 36% had 10-20° valgus. LCPI changed post operatively ranging from +5.0% to -10.7%, average -2.75%. Decrease in LCPI had better cosmetic appearance. Range of motion post operatively increased or remained same as previous full motion in 84% of the patients. Union occurred in all patients by eight weeks. Few complications

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.

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.

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.

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

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.

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

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.

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.

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

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.

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.

Prevalence of skeletal deformity due to nutritional rickets in children between 1 and 18 years in tea garden community.

PubMed

Chabra, Tarun; Tahbildar, Pranjal; Sharma, Ayush; Boruah, Sushanta; Mahajan, Rajat; Raje, Amrut

2016-01-01

The present study was undertaken to find out the prevalence of skeletal deformity due to nutritional rickets in children aged 1-18 years in tea garden community in Dibrugarh District of Assam. It was a cross-sectional study and two-stage cluster sampling was used. In the selected tea gardens, all the children aged 1-18 years were screened for skeletal deformity by house-to-house visit. The overall prevalence of skeletal deformity was 2.7 per thousand. Majority of children with deformities (57.27%) were between 7 and 12 years of age. Widening of wrists and ankle was the most frequent symptom (53.8%). Most of the children with deformity had moderate malnutrition (77.27%). Most of the children with skeletal deformity belong to lower (v) (45.45%) grade of Kuppuswamy's grading scale. Bilateral genu valgus deformity (54.54%) and bilateral genu varum (25.92%) deformity were the most common deformities. Widening of wrists and ankle was the most frequent symptom (61.66%). Of the 16,274 tea garden children included in our study (male and female) in the age group 1-18 years, 44 had skeletal deformity due to nutritional rickets. The prevalence of skeletal deformity due to nutritional rickets was found to be 2.7 per thousand children, which are significantly higher when compared with the only other such study, which was on general population in Bangladesh.

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.

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.

Navigation-Assisted Total Knee Arthroplasty for Patients with Extra-Articular Deformity

PubMed Central

Rhee, Seung Joon; Seo, Chang Hyo

2013-01-01

Purpose Since the existence of an extra-articular deformity seriously alters the normal geometry and kinetics around the knee joint, difficulties are often encountered in total knee arthroplasty (TKA) using a standard surgical technique. The purpose of this study was to evaluate the usefulness of surgical navigation system as a treatment option for osteoarthritic knees with extra-articular deformity. Materials and Methods The authors retrospectively reviewed medical records of the patients who underwent primary TKA between 2007 and 2012. Knees with preoperative radiography showing an angular deformity within the region from the middle third of the femur to the middle third of the tibia in the ipsilateral limb of the arthritic knees were considered as cases having extra-articular deformity. Thirteen knees of the 13 patients were found to have undergone TKA using a navigation system for osteoarthritis with ipsilateral extra-articular deformity. The hip-knee-ankle angle, Knee Society score (KSS), and range of motion were measured before and after the operation to evaluate the improvement. Results The mean hip-knee-ankle angle in the coronal plane was improved to 0.2°±4.5° in valgus alignment postoperatively. The KSS was improved to 89.6±4.6 points postoperatively at the last follow-up, with over 90% of good and excellent results. The range of motion was improved to 118.5°±10.5° postoperatively. Conclusions Navigation-assisted TKA is a good treatment option of osteoarthritic knees with extra-articular deformity. PMID:24368997

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.

[Modern unicondylar knee arthroplasty. Tips and tricks].

PubMed

von Knoch, F; Munzinger, U

2014-05-01

Unicondylar knee arthroplasty (UKA) is an established therapeutic option for advanced medial or lateral gonarthrosis. The cornerstones of a successful UKA, careful patient selection, preoperative planning and precise operation technique, are discussed in this overview article. In contrast to total knee arthroplasty, UKA allows preservation of the contralateral and patellofemoral compartments as well as the cruciate ligaments and is often associated with rapid postoperative recovery, improved knee kinematics and knee function. However, UKA is technically very demanding. High revision rates have been reported in particular with widespread application, according to national joint replacement registries. Successful UKA relies on meticulous patient selection, preoperative planning and surgical technique. It is justified to broaden classic UKA indications. In medial and lateral UKA three types of mechanical varus-valgus deformity can be encountered: type 1 (isolated intraarticular deformity), type 2 (pronounced deformity due to extraarticular varus deformity in medial UKA or valgus deformity in lateral UKA), type 3 (reduced deformity due to extraarticular valgus deformity in medial UKA or varus deformity in lateral UKA). We believe these deformities should be addressed accordingly with surgical technique.

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.

Factors Associated With Callus in Patients with Diabetes, Focused on Plantar Shear Stress During Gait.

PubMed

Hamatani, Masako; Mori, Taketoshi; Oe, Makoto; Noguchi, Hiroshi; Takehara, Kimie; Amemiya, Ayumi; Ohashi, Yumiko; Ueki, Kohjiro; Kadowaki, Takashi; Sanada, Hiromi

2016-11-01

The aim of this study is to identify whether plantar shear stress in neuropathic patients with diabetes with callus is increased compared with those without callus. The differences in foot deformity, limited joint mobility, repetitive stress of walking, and ill-fitting shoes between patients with callus and those without callus were also determined. Subjects were recruited from the Diabetic Foot Outpatient Clinic. A newly developed in-shoe measurement system, which has flexible and thin insoles, enabled measurement of both plantar pressure and shear stress simultaneously when subjects walked as usual on a 10 m walkway. It was found that plantar shear stress adjusted for weight during the push-off phase was increased by 1.32 times in patients with callus compared with those without callus (mean ± SD: 0.0500 ± 0.0160 vs 0.0380 ± 0.0144, P = .031). Moreover, hallux valgus deformity, reduction in dorsiflexion of the ankle joint and increase in plantar flexion were showed in feet with callus. Increased plantar shear stress may be caused by gait change that patients having callus push off with the metatarsal head instead of the toe as a result of foot deformity and limited joint mobility. It was found that plantar shear stress adjusted for weight during the push-off phase was increased in patients with callus compared with those without callus by using the newly developed measurement system. These results suggest that reduction of plantar shear stress during the push-off phase can prevent callus formation in neuropathic patients with diabetes. © 2016 Diabetes Technology Society.

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.

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.

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.

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

Z-plasty of the flexor hallucis longus tendon at tarsal tunnel for checkrein deformity.

PubMed

Lee, Jae Hoon; Kim, Young Jun; Baek, Jong Hun; Kim, Dong Hee

2016-12-01

To review the outcome of Z-plasty of the flexor hallucis longus (FHL) tendon at the tarsal tunnel for checkrein deformity in 8 patients. Records of 6 males and 2 females aged 14 to 67 (mean, 39.5) years who underwent Z-plasty (lengthening) of the FHL tendon at the tarsal tunnel for checkrein deformity in the first and second toes by a single surgeon were reviewed. All patients had undergone 3 months of conservative treatment. The mean time from injury to surgical treatment was 8.4 (range, 5-12) months. All patients had associated injuries including distal tibiofibular fracture (n=6), distal fibular fracture (n=1), and crush injury aroundthe ankle (n=1); they were treated with intramedullary nailing (n=6), long leg splinting (n=1), and short leg splinting (n=1). After a mean follow-up of 3.4 (range, 1-7) years, the FHL tendon was lengthened by a mean of 1.7 (range, 1.6-1.8) cm, and the mean American Orthopedic Foot and Ankle Society hallux score increased from 59 (range, 52-67) to 89 (range, 80-90). No patient had recurrence, nerve injury, or tarsal tunnel syndrome, although one patient had sensory disturbance of the posterior tibial nerve in the forefoot, which resolved spontaneously at week 2. Z-plasty of the FHL tendon at the tarsal tunnel is a viable option for correction of checkrein deformity.

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 Comparison of Two Surgical Techniques Using the Unity Knee™ Total Knee System

ClinicalTrials.gov

2018-04-24

Osteoarthritis, Knee; Rheumatoid Arthritis; Post-Traumatic Osteoarthritis of Knee; Varus Deformity, Not Elsewhere Classified, Knee; Valgus Deformity, Not Elsewhere Classified, Knee; Flexion Deformity, Knee; Fracture of Distal End of Femur; Fracture of Upper End of Tibia

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.

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

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.

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.

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.

Posttraumatic tibia valga: a case demonstrating asymmetric activity at the proximal growth plate on technetium bone scan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zionts, L.E.; Harcke, H.T.; Brooks, K.M.

1987-07-01

Posttraumatic tibia valga is a well-recognized complication following fracture of the upper tibial metaphysis in young children. We present a case of a child who developed a valgus deformity following fracture of the proximal tibia and fibula in which quantitative bone scintigraphy at 5 months after injury demonstrated increased uptake at the proximal tibial growth plate with proportionally greater uptake on the medial side. This finding suggests that the valgus deformity in this patient was due to a relative increase in vascularity and consequent overgrowth of the medial portion of the proximal tibial physis.

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.

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.

Lateral column length in adult flatfoot deformity.

PubMed

Kang, Steve; Charlton, Timothy P; Thordarson, David B

2013-03-01

radiograph in the flatfoot group, the mean medial and lateral column lengths were 167.2 mm and 166.6 mm, respectively; the mean medial and lateral column heights were 16.0 mm and 14.7 mm, respectively; the mean calcaneal pitch angle was 15.6 degrees; and the talus-first metatarsal angle was 10.3 degrees and for the control group, the mean medial and lateral column lengths were 165.3 mm and 163.5 mm, respectively; the mean medial and lateral column heights were 22.8 mm and 13.1 mm, respectively; the mean calcaneal pitch angle was 22.4 degrees; and the talus-first metatarsal angle was -3.6 degrees. None of the differences in measurements for medial and lateral column lengths between the flatfoot and control groups achieved statistical significance. However, statistically significant differences between the 2 groups were observed in the measurements for medial and lateral column heights, talo-navicular uncoverage angle, calcaneal pitch angle, and talus-first metatarsal angle. There is no difference in lateral column lengths between patients with and without adult flatfoot deformity. The perceived shortened lateral column is likely due to forefoot abduction and hindfoot valgus deformities that are associated with adult flatfoot deformity. Level III, comparative series.

"Clothesline technique" for proximal tibial shaft fracture fixation using conventional intramedullary nail: a simple, useful, and inexpensive technique to prevent fracture malalignment.

PubMed

Belangero, William Dias; Santos Pires, Robinson Esteves; Livani, Bruno; Rossi, Felipe Lins; de Andrade, Andre Luis Lugnani

2018-05-01

Treatment of proximal tibial shaft fractures is always challenging. Despite the development of modern techniques, the literature still shows high complication rates, especially regarding proximal fragment malalignment. It is well known that knee position in flexion during tibial nailing is responsible for extension and valgus deformities of the proximal fragment. Unlike in tibial shaft fractures, nails do not reduce proximal tibial fractures due to the medullary canal width. This study aims to describe a simple, useful, and inexpensive technique to prevent valgus and extension deformities when treating proximal tibial fractures using conventional nails: the so-called clothesline technique.

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.

Bilateral stress fracture of the fibulae and periostitis of the tibiae.

PubMed

Tsuchie, Hiroyuki; Okada, Kyoji; Nagasawa, Hiroyuki; Chida, Shuichi; Shimada, Yoichi

2010-01-01

This study describes a unique case of bilateral stress fractures of the fibulae and provides a literature review. A 16-year-old female badminton player presented with pain around the bilateral distal lateral legs. She had mild bilateral varus deformity at the knee joint, and the bilateral ankles showed valgus deformity in standing posture. Radiographs and computed tomography showed periosteal reactions on the bilateral distal fibulae. Technetium-99m bone scintigraphy demonstrated increased uptake in the bilateral distal fibulae and the bilateral middle third of the tibiae. A diagnosis of bilateral distal fibular stress fractures was made. She was advised to stop playing badminton until the symptoms disappeared. Varus deformity of the knee and valgus deformity of the ankle may have influenced the mechanism underlying bilateral symmetric stress fractures. Copyright © 2010 S. Karger AG, Basel.

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.

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.

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.

Knee Deformities in Children With Down Syndrome: A Focus on Knee Malalignment.

PubMed

Duque Orozco, Maria Del Pilar; Abousamra, Oussama; Chen, Brian Po-Jung; Rogers, Kenneth J; Sees, Julieanne P; Miller, Freeman

Patellofemoral instability (PFI) has been the most reported knee abnormality in people with Down syndrome. Other reported knee abnormalities have been associated with PFI and different management approaches have been described with variable outcomes. The aim of this study was to describe the anatomic variations of the knee in children with Down syndrome. A comparison between knees with and without PFI was performed and our experience in treating knee abnormalities in Down syndrome was also reported. Records of all children with Down syndrome were reviewed. Two groups were identified (knees with and without PFI). Radiographic measurements included the mechanical and anatomic lateral distal femoral angles, medial proximal tibial angle, angle of depression of medial tibial plateau, lateral tibial translation, and distal femoral physis-joint angle. On the lateral view, Insall-Salvati and Blackburne-Peel ratios were measured. The sulcus angle was measured on the tangential view. Measurements were compared between the 2 groups (with and without PFI).Knees with PFI were divided into 3 subgroups based on their treatment (group A: surgical valgus correction, group B: surgical soft tissue procedures for PFI, and group C: conservative treatment). Preoperative radiographs were used for the surgical group and last available radiographs were used for the conservative group. Clinical and radiographic data were compared between the groups. For groups A and B, clinical and radiographic data were also compared between preoperative and last visits. Of the 581 children with Down syndrome, 5% (31 children: 22 females, 9 males) had PFI in 56 knees. Mean age at diagnosis was 11.5±3.5 years. Of the remaining 550 children, 75 children had radiographs for 130 knees. Knees with PFI had significantly more valgus and a larger distal femoral physis-joint angle. Depression of the medial tibial plateau and lateral tibial translation were noted in knees with PFI. Insall-Salvati ratio was higher

Transfer of ipsilateral fibula on vascular pedicle for treatment of congenital pseudarthrosis of the tibia.

PubMed

Tan, Jane S; Roach, James W; Wang, Angela A

2011-01-01

Although the use of free vascularized fibula grafts has frequently been reported in the treatment of congenital pseudarthrosis of the tibia, the use of ipsilateral fibula graft on a vascular pedicle is uncommon. We reviewed the long-term results of this procedure in 11 patients. The records of 11 patients who underwent transfer of the ipsilateral fibula on a vascular pedicle between 2.1 and 10.8 years of age were retrospectively reviewed. Average follow-up was 11 years after the index procedure. Seven patients had reached skeletal maturity. Clinical records and radiographs were reviewed to determine patient demographics, surgical parameters, union rate, refracture rate, residual deformity, and functional outcome. Eight patients (73%) achieved union at an average of 20.1 months. Additional bone grafting procedures were required in 4 patients with distal nonunions. There were 3 refractures (38%). Four patients eventually underwent amputation, and 1 patient had a persistent nonunion at final follow-up. Residual deformity included tibial valgus and procurvatum deformities, limb length discrepancy, and ankle valgus. Use of the ipsilateral fibula did not seem to increase the risk of ankle valgus. Functional outcomes were good in all but one patient. Use of the ipsilateral fibula as a pedicle graft provides reasonable results in healing congenital pseudarthrosis of the tibia. Patients should be monitored for the sequelae of this condition, including nonunion, refracture, shortening, and angular deformity, and treated accordingly. Therapeutic Level IV.

Real-time subject-specific monitoring of internal deformations and stresses in the soft tissues of the foot: a new approach in gait analysis.

PubMed

Yarnitzky, G; Yizhar, Z; Gefen, A

2006-01-01

No technology is presently available to provide real-time information on internal deformations and stresses in plantar soft tissues of individuals during evaluation of the gait pattern. Because internal deformations and stresses in the plantar pad are critical factors in foot injuries such as diabetic foot ulceration, this severely limits evaluation of patients. To allow such real-time subject-specific analysis, we developed a hierarchal modeling system which integrates a two-dimensional gross structural model of the foot (high-order model) with local finite element (FE) models of the plantar tissue padding the calcaneus and medial metatarsal heads (low-order models). The high-order whole-foot model provides real-time analytical evaluations of the time-dependent plantar fascia tensile forces during the stance phase. These force evaluations are transferred, together with foot-shoe local reaction forces, also measured in real time (under the calcaneus, medial metatarsals and hallux), to the low-order FE models of the plantar pad, where they serve as boundary conditions for analyses of local deformations and stresses in the plantar pad. After careful verification of our custom-made FE solver and of our foot model system with respect to previous literature and against experimental results from a synthetic foot phantom, we conducted human studies in which plantar tissue loading was evaluated in real time during treadmill gait in healthy individuals (N = 4). We concluded that internal deformations and stresses in the plantar pad during gait cannot be predicted from merely measuring the foot-shoe force reactions. Internal loading of the plantar pad is constituted by a complex interaction between the anatomical structure and mechanical behavior of the foot skeleton and soft tissues, the body characteristics, the gait pattern and footwear. Real-time FE monitoring of internal deformations and stresses in the plantar pad is therefore required to identify elevated deformation

Management of idiopathic and nonidiopathic flatfoot.

PubMed

Frances, Jenny M; Feldman, David S

2015-01-01

Flatfoot in a child may be normal before development of the arch, but the prevalence decreases with age. Treatment is indicated only in the presence of pain and should begin with nonsurgical management options such as stretching of the Achilles tendon and the use of soft shoe orthotics. If pain persists, a modified Evans procedure, together with additional procedures to address forefoot supination, can be successful in correcting deformity and addressing pain. A thorough understanding of the pathology and correction desired will help minimize complications and recurrence. If neuromuscular pathology is present, treatment principles are altered and greatly depend on the severity of the deformity, the association of tibialis posterior spasticity, and ambulatory status. In mild to moderate pathology in walking patients with cerebral palsy, osteotomies can be successful. Various forms of arthrodesis can decrease recurrence when the deformity is severe in a nonambulatory patient with cerebral palsy and a symptomatic valgus foot deformity. In cases of collagen disorders, where soft-tissue laxity complicates management, deformity correction may be of higher importance. Overall alignment always should be evaluated and corrected when necessary to optimize the outcome in patients with valgus foot deformities. The successful treatment of flexible or rigid flatfoot deformity must take into account underlying pathology to optimize outcomes.

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.

Radiographic evaluation for AVN following distal metatarsal Stoffella bunion osteotomy.

PubMed

Klein, Christian; Zembsch, Alexander; Dorn, Ulrich

2009-01-01

Avascular necrosis of the metatarsal head, delayed bone healing and nonunion are complications that may occur after distal first metatarsal osteotomies. Intraoperative damage to the extraosseous blood supply, the location of the osteotomy and postoperative vasospasm have been cited as possible causes of such changes. We evaluated Stoffella's subcapital osteotomies which were performed at our department for the correction of moderate to severe hallux valgus deformities. Standardized radiographs of 300 feet, taken 6weeks, 3 months, and 6 months postoperatively and at the final followup were examined with regard to postoperative AVN or signs of delayed bone healing. Of 228 patients, 202 were women and 26 were men. The patients' mean age was 49 years, and the mean followup was 12 months. In 278 cases the radiographs revealed an unremarkable first metatarsal head. Seventeen cases showed diffuse or localized osteopenia or small cysts in the subchondral bone. These changes fully resolved on subsequent radiographs. The X-rays of two patients revealed progressive narrowing of the joint space, irregular contours on the surface of the joint and an abnormal bone structure. The patients subsequently developed a characteristic picture of avascular necrosis, in one case combined with nonunion. Three patients had delayed bone healing, but ultimately healed successfully. Ischemic changes in bone are known to occur after distal first metatarsal osteotomies. There is a very low incidence of postoperative perfusion problems after Stoffella;s technique, even with lateral soft tissue release.

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.

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.

[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

[Coxa vara. Isolated growth of the greater trochanter. Prevention-treatment].

PubMed

Litt, R; Albassir, A; Willems, S; Debry, R

1990-01-01

Prevention of avascular complications is a primary aim. The ischemic insult to the femoral head provokes different types of morphologic deformities depending on its location. When the lateral part of the growth plate is affected, the head will be in valgus with a short neck, on the contrary, when the medial part is affected, a coxa vara occurs. The sooner the growth is stopped, the shorter the neck will be. Nevertheless, the greater trochanter will continue its growth and under certain conditions, will extend beyond the head. The Articulo-Trochanteric Distance is a measurement of the deformity which may be checked regularly. Early recognition permits prevention and adequate treatment. Treatment options include epiphysiodesis of the greater trochanter before the age of 8 to 10 years, trochanteric repositioning with osteotomy, and valgus osteotomy (Pauwels' Y-osteotomy).

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

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.

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

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.

[Mid-term effectiveness of rotating hinge knee prosthesis for severe knee deformity].

PubMed

Zeng, Min; Hu, Yihe; Xie, Jie; Li, Mingqing; Lin, Shaoru

2014-01-01

To evaluate the mid-term effectiveness of rotating hinge knee prosthesis for severe knee deformity. A retrospective analysis was made on the clinical data of 24 patients (24 knees) who received rotating hinge knee prosthesis for total knee arthroplasty between January 2003 and June 2011. There were 14 males and 10 females, aged from 60 to 81 years (mean, 70 years). The disease causes included osteoarthritis in 5 cases, rheumatoid arthritis in 7 cases, traumatic arthritis in 9 cases, and Charcot's arthropathy in 3 cases. The disease duration ranged from 5 to 25 years (mean, 14.5 years). Of them, 13 cases had flexion deformity, 7 cases had valgus deformity, and 16 cases had varus deformity. The operation time, the amount of bleeding between operation and drainage-tubes removal, hospitalization time, incision healing, and complications were recorded. The results were evaluated according to Knee Society Score (KSS), visual analogue scale (VAS), and the range of motion (ROM) of knee. Short-form 36 health survey scale (SF-36) was used to evaluate the life quality of patients. The position of prosthesis was observed through X-ray examination. The operation time ranged from 70 to 90 minutes (mean, 78 minutes). The amount of bleeding between operation and drainage-tubes removal ranged from 400 to 1 000 mL (mean, 650 mL). The hospitalization time ranged from 14 to 18 days (mean, 15.2 days). Patellar fracture occurred in 1 case (4.17%) during operation, swelling and effusion of incision in 1 case (4.17%), and periprosthetic infections in 2 cases (8.33%) after operation. All patients were followed up 2-10 years (mean, 5.5 years). The X-ray films showed no evidence of obvious radiolucent line, osteolysis, prosthesis subsidence, and limb alignment change. The results of KSS, VAS socres, and ROM of knee at 1 year postoperatively and last follow-up were significantly better than preoperative ones (P < 0.05), but no significant difference was found between at 1 year postoperatively

First Tarsometatarsal Arthrodesis: An Anatomic Evaluation of Dorsomedial Versus Plantar Plating.

PubMed

Simons, Paul; Fröber, Rosemarie; Loracher, Clemens; Knobe, Matthias; Gras, Florian; Hofmann, Gunther O; Klos, Kajetan

2015-01-01

Fusion of the first tarsometatarsal joint is a widely used procedure for the correction of hallux valgus deformity. Although dorsomedial H-shaped plating systems are being increasingly used, fusion can also be achieved by plantar plating. The goal of the present study was to compare these 2 operative techniques based on the anatomic considerations and show the potential pitfalls of both procedures. Six pairs of deep-frozen human lower legs were used in the present cadaveric study. In a randomized manner, either dorsomedial arthrodesis or plantar plating through a medial incision was performed. With regard to arterial injury, the plantar technique resulted in fewer lesions (plantar, 4 injuries [66.7%] to the terminal branches of the first digital branch of the medial plantar artery; dorsomedial, 3 injuries [50%] to the main trunks of the plantar metatarsal arteries and the first dorsal metatarsal artery). With respect to injury to the veins, the plantar procedure affected significantly fewer high-caliber subcutaneous trunk veins. The nerves coursing through the operative field, such as the saphenous and superficial fibular nerves, were compromised more often by the dorsal approach. Neither the plantar plating nor the dorsomedial plating technique was associated with injury to the insertion of the tibialis anterior muscle. Both studied techniques are safe, well-established procedures. Arthrodesis with plantar plating, however, offers additional advantages and is a reliable tool in the foot and ankle surgeon's repertoire. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

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.

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

RHEUMATOID ARTHRITIS. PHYSICAL MEASURES IN TREATMENT OF CHILDREN.

PubMed

EISING, L M; SOULES, B

1964-05-01

Prognosis in rheumatic arthritis in children is good, provided total care is given, deformity prevented and function maintained. Bed rest is desirable until active inflammation of the joints has subsided. During convalescence a balance between rest and exercise must be maintained to avoid recurrence of inflammation of the joints. When there is progressive deformity or disabling pain in the wrist, a molded leather wrist-cuff splint can control the deformity, decrease or abolish pain and lessen swelling. If there is valgus deformity of the knee or external rotation of the tibia, with no more than ten degrees of knee flexion deformity, correction can be obtained by simple manipulations.

Three-dimensional printing as a technology supporting the treatment of lower limb deformity and shortening with the Ilizarov method.

PubMed

Morasiewicz, Piotr; Burzyńska, Karolina; Orzechowski, Wiktor; Dragan, Szymon Łukasz; Dragan, Szymon Feliks; Filipiak, Jarosław

2018-04-20

Treatment of multiplanar deformities, especially in younger children, requires construction of a complex Ilizarov fixator, frequently with small dimensions. The aim of this study is to verify clinical application of a3D-printed bone model in treatment with the Ilizarov method. The study involved a 6-year-old child in whom clinical and radiological examination revealed multiplanar deformity of the right leg. Then, 3D models of individual bones were printed by means of additive manufacturing and were used as a scaffold to install the Ilizarov apparatus. To compare the expected and factual axial correction and lengthening, we measured spatial orientation of bone fragments three times. The factual axial correction and lengthening were determined with a photometric technique. Ilizarov fixator with a configuration developed using a 3D model of the treated bone was mounted on the patient's leg. Corticotomy was carried out at the proximal metaphysis of the right tibia, along with osteotomy of the right talus. The treatment resulted in a 3.5-cm lengthening of the limb and a 7° correction of valgus angle. The values of actual lengthening and axial correction were 4.1% lower than the expected values of these parameters. Orthopedists should consider differences between the expected and actual lengthening and axial correction in planning treatment with the Ilizarov method. Three-dimensional printing is a useful technology that can be used to support treatment with the Ilizarov method. Copyright © 2018 IPEM. Published by Elsevier Ltd. All rights reserved.

Skeletal deformities associated with nutritional congenital rickets in newborn lambs.

PubMed

Dittmer, K E; Morley, R E; Smith, R L

2017-01-01

A group of 545 pregnant rising 2-year-old Coopdale ewes on a Southland sheep farm were grazed over winter on a fodder beet (Beta vulgaris) crop. Subsequently, 45 out of approximately 750 lambs were born with a variety of skeletal deformities, including shortened limbs, varus and valgus angular limb deformities, palmar grade stance and cranial bowing of the carpus. Analysis of the crop showed the fodder beet contained a low percentage of phosphorus. In addition, 60 out of 460 rising 2-year-old ewes that had been grazed on the fodder beet crop as 1-year-olds had incisor abnormalities and malocclusion. Two affected lambs (1-day-old and 3-days-old) with representative clinical signs examined postmortem were found to have markedly enlarged costochondral junctions, and noticeably enlarged long bone metaphyses. In addition, one lamb had a dense band of metaphyseal sclerosis beneath the physes of all long bones examined. Histopathological findings included small islands and columns of chondrocytes and eosinophilic cartilage matrix present in the metaphysis. Metaphyseal trabeculae were disorganised and often lined by accumulations of pale pink osteoid; similar pale pink osteoid was also present in the cortices. Unerupted molar teeth in the affected lambs lacked a layer of enamel, and the dentine was irregular with globular basophilia. The gross and histopathological lesions were consistent with a diagnosis of rickets. Nutritional congenital rickets has not been previously diagnosed in sheep, but is a recognised disease of human infants with vitamin D deficient mothers. The rickets in affected lambs was most likely associated with phosphorus deficiency as a result of the pregnant ewes grazing fodder beet during gestation. While vitamin D deficiency was not definitively ruled out in these cases, practitioners are alerted to the possible effects of feeding phosphorus-deficient fodder beet to ewes for long periods during gestation and to 1-year-old sheep during important growth

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.

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.

Laxity after complete release of the medial collateral ligament in primary total knee arthroplasty.

PubMed

Cho, Woo-Shin; Byun, Seong-Eun; Lee, Sang-Jun; Yoon, Jaeyoun

2015-06-01

Medial collateral ligament (MCL) release is one of the essential steps toward the achievement of ligament balancing during the total knee arthroplasty (TKA) in patients with varus deformity. When the varus deformity is severe, complete release of the MCL until balanced is often required. However, it is believed that complete MCL release may lead to catastrophic laxity. The purpose of this prospective study is to compare the medial joint gap opening in postoperative valgus stress radiograph in patients with complete MCL release against patients with partial release. Out of 209 primary TKAs performed for degenerative osteoarthritis, complete MCL release was required in 33 cases (group I) by sub-periosteal detachment at proximal tibia using periosteal elevator. For the remaining 176 knees (group II), partial release of MCL was done. At postoperative 6 months and 1 year, both groups were evaluated for comparing the joint gap on valgus stress radiographs using modified Telos device in 0°, 45°, and 90° of flexion. Additional parameters which were analyzed included preoperative varus and valgus stress radiographs in full extension and pre- and postoperative mechanical alignment in each group. The knee range of motion (ROM) and clinical scores were evaluated at 1-year follow-up. The mean values of the joint opening on the postoperative valgus stress test with the knee joint extended, and in the 45° and 90° flexed states at 6 months and at 1 year postoperatively in group I were not statistically significantly different from those of group II. The clinical scores also did not show a statistically significant difference between two groups. There was a statistically significant difference in ROM between two groups, pre- and postoperatively and the difference was 5°, respectively. This study suggests that complete MCL release for ligament balancing is a safe procedure and does not lead to postoperative laxity.

Treatment of shepherd’s crook deformity in patients with polyostotic fibrous dysplasia using a new type of custom made retrograde intramedullary nail: a technical note

PubMed Central

Hefti, F.; Donnan, L.; Krieg, A. H.

2017-01-01

Aims The severe form of coxa vara, the ‘shepherd’s crook deformity’, is always a consequence of a locally extensive form of polyostotic fibrous dysplasia (or McCune-Albright syndrome). Treatment of this deformity is a challenge. The soft bone does not tolerate any implant that depends on the stability of the cortical bone (like plates or external fixators). Intramedullary nails are the most appropriate implants for stabilisation, but if they are inserted from the greater trochanter, they cannot correct the varus deformity enough. Patients and Methods We have developed a special intramedullary nail that can be inserted from the osteotomy site and can be driven retrograde into the femoral neck in an appropriate valgus position. We have operated 15 legs in 13 patients. The average age at surgery was 14 years and 5 months (6 to 28.9). In all, 11 femora had been operated before (unsuccessfully) with various implants. Results The average follow-up was 54.2 months (7 to 132). The average correction of the neck/(distal) shaft angle was 57.5° (10° to 80°) ( = 72.8%). While pre-operatively none of the patients was able to walk without aid, at follow-up only one patient was unable to walk, three used the aid of crutches because of tibial lesions and one patient had an increased external rotation of the leg. At follow-up, most patients were free of pain. One implant broke and had to be replaced. Conclusion This new operative method offers the possibility of efficient correction and stabilisation of this severe and difficult deformation. PMID:28439311

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 �

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

Burnei's technique of femoral neck variation and valgisation by using the intramedullary rod in Osteogenesis imperfecta.

PubMed

Georgescu, I; Gavriliu, Șt; Nepaliuc, I; Munteanu, L; Țiripa, I; Ghiță, R; Japie, E; Hamei, S; Dughilă, C; Macadon, M

2014-01-01

Varus or valgus deviations of the femoral neck in osteogenesis imperfecta have been an ignored chapter because the classic correction procedures were applied in medical practice with unsatisfying results. Until the use of telescopic rods, coronal deviations remained unsolved and the distal configuration of the proximal femoral extremity remained uncorrected or partially corrected, which required an extensive use of the wheel chair or bed immobilization of the patient. The concomitant correction of the complex deformities, coxa vara/valga and femoral integrated configuration, have been a progress which allowed the patients to walk with or without support. The purpose of this study is to present the Burnei's technique, a therapeutic alternative in deformity corrections of the varus or valgus hip in children with osteogenesis imperfecta. The paper is about a retrospective study done in a single center, which analyses Burnei technique and other procedures described in literature. The content of the article is based on a 12 years experience on a batch of 51 patients with osteogenesis imperfecta from which 10 patients (13 hips) presented frontal plane deviations of the femoral neck. All the patients with osteogenesis imperfecta who presented coxa vara or valga were submitted to investigations with the purpose of measuring blood loss, the possibility of extending the surgical intervention to the leg, the association of severe deformities of the proximal extremity of the femur and the necessity of postoperative intensive care. Burnei's technique: The operation was first performed in 2002. A subtrochanteric osteotomy was made in an oblique cut, from the internal side to the external side and from proximal to distal for coxa vara, or by using a cuneiform resection associated with muscular disinsertions. Only telescopic rods were used for osteosynthesis. There are a few articles in literature, which approach corrections of vara or valgus deviations in osteogenesis imperfecta

An Anatomic Study on Whether the Immature Patella is Centered on an Anteroposterior Radiograph.

PubMed

Kyriakedes, James C; Liu, Raymond W

2017-03-01

In the operating room, after first obtaining a proper lateral radiograph with the condyles superimposed, a 90-degree rotation of the intraoperative fluoroscopy unit does not always produce an anteroposterior (AP) image with the patella centered. The orthogonality of these 2 views has not been well determined in children. This study was comprised of a radiographic group (35 knees) and a cadaveric group (59 knees). Both cadaveric and clinical images were obtained by resting or positioning the femur with the posterior condyles overlapped, and then taking an orthogonal AP image. Centering of the patella was calculated and multiple regression analysis was performed to determine the relationship between patellar centering and age, sex, ethnicity, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), and contralateral centering. Mean patellar centering, expressed as the lateral position of the patella with respect to the total condylar width, was 0.08±0.10 in the radiographic group and 0.06±0.03 in the cadaveric group. Positive (lateral) patellar centering in 1 knee had a statistically significant correlation with positive patellar centering in the contralateral knee in both the radiographs and the cadavers. In the radiographic group, there was a statistically significant correlation between femoral varus and valgus deformities and positive patellar centering. In the cadaveric group, there was a statistically significant correlation between tibial valgus and negative (medial) patellar centering. The patella in an immature knee is rarely perfectly centered on a true AP image, and is usually seated slightly laterally within the femoral condyles. Obtaining a true AP intraoperative radiograph is critical to analyzing and correcting valgus and varus deformities, and in the proper placement of implants. When addressing knee deformity one should consider obtaining an AP view orthogonal either to a perfect lateral of the knee or orthogonal to the

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.

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.

Axial correction of the lower limb deformities in a girl with anauxetic dysplasia.

PubMed

Kenis, Vladimir; Grill, Franz; Al Kaissi, Ali

2014-06-01

Valgus subtrochanteric osteotomies and hemiepiphyseodesis around the knees have been performed to correct severe coxa vara and genua valga in a girl patient who manifested extreme dwarfism associated with spondylometaepiphyseal dysplasia consistent with anauxetic dysplasia. To the best of our knowledge, this is the first description of the combined orthopaedic intervention in a girl with anauxetic dysplasia.

Global synthesis of volcano deformation: Results of the Volcano Deformation Task Force

NASA Astrophysics Data System (ADS)

Pritchard, M. E.; Jay, J.; Biggs, J.; Ebmeier, S. K.; Delgado, F.

2013-12-01

Ground deformation in volcanic regions is being observed more frequently -- the number of known deforming volcanoes has increased from 44 in 1997 to more than 210 in 2013 thanks in large part thanks to the availability of satellite InSAR observations. With the launch of new SAR satellites in the coming years devoted to global deformation monitoring, the number of well-studied episodes of volcano deformation will continue to increase. But evaluating the significance of the observed deformation is not always straightforward -- how often do deformation episodes lead to eruption? Are there certain characteristics of the deformation or the volcano that make the linkage between deformation and eruption more robust -- for example the duration or magnitude of the ground deformation and/or the composition and tectonic setting of the volcano? To answer these questions, a global database of volcano deformation events is needed. Recognizing the need for global information on volcano deformation and the opportunity to address it with InSAR and other techniques, we formed the Volcano Deformation Database Task force as part of Global Volcano Model. The three objectives of our organization are: 1) to compile deformation observations of all volcanoes globally into appropriate formats for WOVOdat and the Global Volcanism Program of the Smithsonian Institution. 2) document any relation between deformation events and eruptions for the Global assessment of volcanic hazard and risk report for 2015 (GAR15) for the UN. 3) to better link InSAR and other remote sensing observations to volcano observatories. We present the first results from our global study of the relation between deformation and eruptions, including case studies of particular eruptions. We compile a systematically-observed catalog of >500 volcanoes with observation windows up to 20 years. Of 90 volcanoes showing deformation, 40 erupted. The positive predictive value (PPV = 0.44) linking deformation and eruption on this

Severe valgus deformity of the knee with permanent patellar dislocation associated with melorheostosis: a case report and review of the literature.

PubMed

Kitta, Yuki; Niki, Yasuo; Udagawa, Kazuhiko; Enomoto, Hiroyuki; Toyama, Yoshiaki; Suda, Yasunori

2014-03-01

We present a case of an 8-year-old boy diagnosed with melorheostosis who was suffering from severe genu valgum, permanent dislocation of the patella, knee flexion contracture and leg length shortening. Soft tissue contracture of the limb and subsequent joint deformities were reported to represent clinical manifestations of pediatric melorheostosis. As the epiphyseal plate had not closed, patellar reduction was achieved by soft tissue surgical stabilization, including lateral retinacular release, medial retinaculum plication, and transfer of the lateral half of the patellar tendon. At 4 years postoperatively, as a result of improved limb alignment and knee flexion contracture, the leg length shortening has improved, and the patient does not limp and participates in sports activities. Surgical intervention should be performed as early as possible, because genu valgum and external rotation of the tibia may deteriorate with age, rendering the patellar dislocation irreversible in patients with melorheostosis before epiphyseal closure. Copyright © 2012 Elsevier B.V. All rights reserved.

Mechanical Failure Mode of Metal Nanowires: Global Deformation versus Local Deformation

PubMed Central

Ho, Duc Tam; Im, Youngtae; Kwon, Soon-Yong; Earmme, Youn Young; Kim, Sung Youb

2015-01-01

It is believed that the failure mode of metal nanowires under tensile loading is the result of the nucleation and propagation of dislocations. Such failure modes can be slip, partial slip or twinning and therefore they are regarded as local deformation. Here we provide numerical and theoretical evidences to show that global deformation is another predominant failure mode of nanowires under tensile loading. At the global deformation mode, nanowires fail with a large contraction along a lateral direction and a large expansion along the other lateral direction. In addition, there is a competition between global and local deformations. Nanowires loaded at low temperature exhibit global failure mode first and then local deformation follows later. We show that the global deformation originates from the intrinsic instability of the nanowires and that temperature is a main parameter that decides the global or local deformation as the failure mode of nanowires. PMID:26087445

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.

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.

Deformation measurement for a rotating deformable lap based on inverse fringe projection

NASA Astrophysics Data System (ADS)

Liao, Min; Zhang, Qican

2015-03-01

The active deformable lap (also namely stressed lap) is an efficient polishing tool in optical manufacturing. To measure the dynamic deformation caused by outside force on a deformable lap is important and helpful to the opticians to ensure the performance of a deformable lap as expected. In this paper, a manual deformable lap was designed to simulate the dynamic deformation of an active stressed lap, and a measurement system was developed based on inverse projected fringe technique to restore the 3D shape. A redesigned inverse fringe has been projected onto the surface of the measured lap, and the deformations of the tested lap become much obvious and can be easily and quickly evaluated by Fourier fringe analysis. Compared with the conventional projection, this technique is more obvious, and it should be a promising one in the deformation measurement of the active stressed lap in optical manufacturing.

Deformation twinning in a creep-deformed nanolaminate structure

NASA Astrophysics Data System (ADS)

Hsiung, Luke L.

2010-10-01

The underlying mechanism of deformation twinning occurring in a TiAl-(γ)/Ti3Al-(α2) nanolaminate creep deformed at elevated temperatures has been studied. Since the multiplication and propagation of lattice dislocations in both γ and α2 thin lamellae are very limited, the total flow of lattice dislocations becomes insufficient to accommodate the accumulated creep strains. Consequently, the movement of interfacial dislocations along the laminate interfaces, i.e., interface sliding, becomes an alternative deformation mode of the nanolaminate structure. Pile-ups of interfacial dislocations occur when interfacial ledges and impinged lattice dislocations act as obstacles to impede the movement of interfacial dislocations. Deformation twinning can accordingly take place to relieve a stress concentration resulting from the pile-up of interfacial dislocations. An interface-controlled twinning mechanism driven by the pile-up and dissociation of interfacial dislocations is accordingly proposed.

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.

[Humerus varus: correction by proximal valgus osteotomy with precontourned plate fixation in children].

PubMed

Tallón-López, J; Domínguez-Amador, J J; Andrés-García, J A

2014-01-01

Varus deformity of the proximal humerus in children is a little known pathology due to its low incidence of presentation. Progress has been made in recent years in understanding the possible etiology and pathophysiological causes. Radiological criteria for diagnosis and functional impairment that occurs have also been defined. However, there are few reports in the literature about the surgical treatment of this deformity in children. In this paper we present a case of surgical treatment of this deformity by corrective osteotomy fixed with precontoured external maleolar plate osteosynthesis. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

The properties of Q-deformed hyperbolic and trigonometric functions in quantum deformation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Deta, U. A., E-mail: utamaalan@yahoo.co.id, E-mail: utamadeta@unesa.ac.id; Suparmi

2015-09-30

Quantum deformation has been studied due to its relation with applications in nuclear physics, conformal field theory, and statistical-quantum theory. The q-deformation of hyperbolic function was introduced by Arai. The application of q-deformed functions has been widely used in quantum mechanics. The properties of this two kinds of system explained in this paper including their derivative. The graph of q-deformed functions presented using Matlab. The special case is given for modified Poschl-Teller plus q-deformed Scarf II trigonometry potentials.

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

Models of determining deformations

NASA Astrophysics Data System (ADS)

Gladilin, V. N.

2016-12-01

In recent years, a lot of functions designed to determine deformation values that occur mostly as a result of settlement of structures and industrial equipment. Some authors suggest such advanced mathematical functions approximating deformations as general methods for the determination of deformations. The article describes models of deformations as physical processes. When comparing static, cinematic and dynamic models, it was found that the dynamic model reflects the deformation of structures and industrial equipment most reliably.

Long-term results of fibular-Achilles tenodesis (Westin's tenodesis) for paralytic pes calcaneus: is hypercorrection avoidable? A longitudinal retrospective study.

PubMed

Yamada, Helder Henzo; Fucs, Patricia Maria Moraes de Barros

2017-08-01

The purpose of this study was to review all cases of patients submitted to Westin's tenodesis, who had calcaneus feet secondary to myelomeningocele sequel, in order to evaluate the anatomical change provided by surgery and also to verify, in a long-term follow-up, the inversion of the deformity depending on the patient's age. In this longitudinal retrospective study, all medical records of patients with myelomeningocele sequelae submitted to Westin's tenodesis from 1993 to 2013 in a public university hospital were reviewed. Patients were contacted for new clinical and radiographic evaluations after a minimum of 36 months after surgery. The calcaneotibial angle was measured and the shortening of the fibula was calculated as the "intermalleolar height". The study was based on 16 children (26 feet), aged 84.27 months on average at the time of tenodesis. The calcaneotibial angle increased significantly post-operatively, from 63.77 degrees on average to 70.54 degrees. Intermalleolar height and valgus ankle did not change significantly. Most patients had plantigrade feet after surgery, without pressure ulcers, and were able to use orthoses. Westin's tenodesis, with or without other associated procedures, can correct or improve the calcaneus and valgus ankle deformity in patients with myelomeningocele sequelae. There was no association of the surgical result with age at the time of surgery. There was no inversion of the deformity in equinus during the follow-up time.

Outcomes After Interpositional Arthroplasty of the First Metatarsophalangeal Joint.

PubMed

Aynardi, Michael C; Atwater, Lara; Dein, Eric J; Zahoor, Talal; Schon, Lew C; Miller, Stuart D

2017-05-01

For patients with hallux rigidus seeking a motion-sparing procedure, interposition arthroplasty is an alternative to fusion. The purpose of this study was to report patient outcomes after interpositional arthroplasty for hallux rigidus. All patients undergoing interpositional arthroplasty at our institution from 2001 to 2014 were identified and a retrospective chart review was performed. Follow-up was conducted through a telephone survey to obtain survivorship, satisfaction, and functional scores. Survivorship of the interpositional arthroplasty procedure was defined as no subsequent surgery on the hallux after the index procedure. Patients were excluded for incomplete records. Complications were recorded. From 2001 to 2014, 183 patients were identified. Of these, 14 were excluded for incomplete data, leaving 169 patients. Of these, 133 had an average follow-up of 62.2 months (range, 24.3 months to 151.2 months). The overall failure rate was 3.8% (5/133). Patient-reported outcome was rated as excellent in 65.4% (87/133) or good in 24.1% (32/133) of patients and fair or poor in 10.5% (14/133) of patients. Of 133 patients, 101 (76%) were able to return to fashionable or regular footwear. The infection rate was 1.5% (2/133). Patient-reported cock-up deformity of the first metatarsophalangeal joint (MTPJ) occurred in 4.5% (6/133) of patients. In addition, 17.3% (23/133) of patients reported metatarsalgia of the second or third MTPJ at the time of final follow-up, and there was no significant difference between interposition types ( P = .441). Interpositional arthroplasty for hallux rigidus was found to have excellent or good results in most patients at a mean follow-up of 62.2 months. Level IV, retrospective case series.

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.

Analysis of Mining Terrain Deformation Characteristics with Deformation Information System

NASA Astrophysics Data System (ADS)

Blachowski, Jan; Milczarek, Wojciech; Grzempowski, Piotr

2014-05-01

Mapping and prediction of mining related deformations of the earth surface is an important measure for minimising threat to surface infrastructure, human population, the environment and safety of the mining operation itself arising from underground extraction of useful minerals. The number of methods and techniques used for monitoring and analysis of mining terrain deformations is wide and increasing with the development of geographical information technologies. These include for example: terrestrial geodetic measurements, global positioning systems, remote sensing, spatial interpolation, finite element method modelling, GIS based modelling, geological modelling, empirical modelling using the Knothe theory, artificial neural networks, fuzzy logic calculations and other. The aim of this paper is to introduce the concept of an integrated Deformation Information System (DIS) developed in geographic information systems environment for analysis and modelling of various spatial data related to mining activity and demonstrate its applications for mapping and visualising, as well as identifying possible mining terrain deformation areas with various spatial modelling methods. The DIS concept is based on connected modules that include: the spatial database - the core of the system, the spatial data collection module formed by: terrestrial, satellite and remote sensing measurements of the ground changes, the spatial data mining module for data discovery and extraction, the geological modelling module, the spatial data modeling module with data processing algorithms for spatio-temporal analysis and mapping of mining deformations and their characteristics (e.g. deformation parameters: tilt, curvature and horizontal strain), the multivariate spatial data classification module and the visualization module allowing two-dimensional interactive and static mapping and three-dimensional visualizations of mining ground characteristics. The Systems's functionality has been presented on

Posterior cruciate-retaining versus posterior-stabilized total knee arthroplasty for osteoarthritis with severe varus deformity.

PubMed

Ünkar, Ethem Ayhan; Öztürkmen, Yusuf; Şükür, Erhan; Çarkçı, Engin; Mert, Murat

2017-03-01

The aim of this study was to compare the radiological and functional results of posterior cruciate ligament (PCL) - retaining and posterior-stabilized total knee arthroplasties in patients with severe varus gonarthrosis. Medical records of 112 knees of 96 patients who underwent total knee arthroplasty for severe varus (≥15°) were reviewed. PCL-retaining and PCL-stabilizing groups consisted of 58 and 54 knees, respectively. Mean follow-up time was 56.6 months (range: 24-112 months). Knee Society (KS) clinical rating system was used in clinical evaluation. Range of motion, degree of flexion contracture, postoperative alignment, and complication rates were compared between the groups. Mean preoperative mechanical tibiofemoral angle was 20.1° in varus alignment, and was restored to 4.6° in valgus postoperatively. No statistically significant differences were found between PCL-stabilizing and PCL-retaining groups when KS knee scores, function scores, and flexion arc were evaluated. Two patients in PCL-retaining group underwent revision surgery due to aseptic loosening of tibial component. One patient in PCL-stabilizing group needed arthrotomy due to patellar clunk syndrome. There were no notable differences between the 2 groups and PCL-retaining design had outcomes as good as PCL-stabilizing total knee implant in osteoarthritic knees with severe varus deformity. Level III, Therapeutic study. Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

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.

Deformation mechanisms in experimentally deformed Boom Clay

NASA Astrophysics Data System (ADS)

Desbois, Guillaume; Schuck, Bernhard; Urai, Janos

2016-04-01

Bulk mechanical and transport properties of reference claystones for deep disposal of radioactive waste have been investigated since many years but little is known about microscale deformation mechanisms because accessing the relevant microstructure in these soft, very fine-grained, low permeable and low porous materials remains difficult. Recent development of ion beam polishing methods to prepare high quality damage free surfaces for scanning electron microscope (SEM) is opening new fields of microstructural investigation in claystones towards a better understanding of the deformation behavior transitional between rocks and soils. We present results of Boom Clay deformed in a triaxial cell in a consolidated - undrained test at a confining pressure of 0.375 MPa (i.e. close to natural value), with σ1 perpendicular to the bedding. Experiments stopped at 20 % strain. As a first approximation, the plasticity of the sample can be described by a Mohr-Coulomb type failure envelope with a coefficient of cohesion C = 0.117 MPa and an internal friction angle ϕ = 18.7°. After deformation test, the bulk sample shows a shear zone at an angle of about 35° from the vertical with an offset of about 5 mm. We used the "Lamipeel" method that allows producing a permanent absolutely plane and large size etched micro relief-replica in order to localize and to document the shear zone at the scale of the deformed core. High-resolution imaging of microstructures was mostly done by using the BIB-SEM method on key-regions identified after the "Lamipeel" method. Detailed BIB-SEM investigations of shear zones show the following: the boundaries between the shear zone and the host rock are sharp, clay aggregates and clastic grains are strongly reoriented parallel to the shear direction, and the porosity is significantly reduced in the shear zone and the grain size is smaller in the shear zone than in the host rock but there is no evidence for broken grains. Comparison of microstructures

From progressive to finite deformation, and back: the universal deformation matrix

NASA Astrophysics Data System (ADS)

Provost, A.; Buisson, C.; Merle, O.

2003-04-01

It is widely accepted that any finite strain recorded in the field may be interpreted in terms of the simultaneous combination of a pure shear component with one or several simple shear components. To predict strain in geological structures, approximate solutions may be obtained by multiplying successive small increments of each elementary strain component. A more rigorous method consists in achieving the simultaneous combination in the velocity gradient tensor but solutions already proposed in the literature are valid for special cases only and cannot be used, e.g., for the general combination of a pure shear component and six elementary simple shear components. In this paper, we show that the combination of any strain components is as simple as a mouse click, both analytically and numerically. The finite deformation matrix is given by L=exp(L.Δt) where L.Δt is the time-integrated velocity gradient tensor. This method makes it possible to predict finite strain for any combination of strain components. Reciprocally, L.Δt=ln(D) , which allows to unravel the simplest deformation history that might be liable for a given finite deformation. Given the strain ellipsoid only, it is still possible to constrain the range of compatible deformation matrices and thus the range of strain component combinations. Interestingly, certain deformation matrices, though geologically sensible, have no real logarithm so cannot be explained by a deformation history implying strain rate components with constant proportions, what implies significant changes of the stress field during the history of deformation. The study as a whole opens the possibility for further investigations on deformation analysis in general, the method could be used wathever the configuration is.

TU-H-CAMPUS-JeP1-05: Dose Deformation Error Associated with Deformable Image Registration Pathways

DOE Office of Scientific and Technical Information (OSTI.GOV)

Surucu, M; Woerner, A; Roeske, J

Purpose: To evaluate errors associated with using different deformable image registration (DIR) pathways to deform dose from planning CT (pCT) to cone-beam CT (CBCT). Methods: Deforming dose is controversial because of the lack of quality assurance tools. We previously proposed a novel metric to evaluate dose deformation error (DDE) by warping dose information using two methods, via dose and contour deformation. First, isodose lines of the pCT were converted into structures and then deformed to the CBCT using an image based deformation map (dose/structure/deform). Alternatively, the dose matrix from the pCT was deformed to CBCT using the same deformation map,more » and then the same isodose lines of the deformed dose were converted into structures (dose/deform/structure). The doses corresponding to each structure were queried from the deformed dose and full-width-half-maximums were used to evaluate the dose dispersion. The difference between the FWHM of each isodose level structure is defined as the DDE. Three head-and-neck cancer patients were identified. For each patient, two DIRs were performed between the pCT and CBCT, either deforming pCT-to-CBCT or CBCT-to-pCT. We evaluated the errors associated by using either of these pathways to deform dose. A commercially available, Demons based DIR was used for this study, and 10 isodose levels (20% to 105%) were used to evaluate the errors in various dose levels. Results: The prescription dose for all patients was 70 Gy. The mean DDE for CT-to-CBCT deformation was 1.0 Gy (range: 0.3–2.0 Gy) and this was increased to 4.3 Gy (range: 1.5–6.4 Gy) for CBCT-to-CT deformation. The mean increase in DDE between the two deformations was 3.3 Gy (range: 1.0–5.4 Gy). Conclusion: The proposed DDF was used to quantitatively estimate dose deformation errors caused by different pathways to perform DIR. Deforming dose using CBCT-to-CT deformation produced greater error than CT-to-CBCT deformation.« less

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

Analysis of foot kinematics wearing high heels using the Oxford foot model.

PubMed

Wang, Meizi; Gu, Yaodong; Baker, Julien Steven

2018-04-29

Wearing high heels is thought to lead to various foot disorders and injuries such as metatarsal pain, Achilles tendon tension, plantar fasciitis and Haglund malformation. However, there is little available information explaining the specific mechanisms and reasons why wearing high heels causes foot deformity. Therefore, the purpose of this study was to investigate the foot kinematics of high heel wearers and compare any differences with barefoot individuals using the Oxford Foot Model (OFM). Fifteen healthy women aged 20-25 years were measured while walking barefoot and when wearing high heels. The peak value of angular motion for the hallux with respect to the forefoot, the forefoot with respect to the hind foot, and the hind foot with respect to the tibia were all analyzed. Compared to the barefoot, participants wearing high heels demonstrated larger hallux dorsiflexion (22.55∘± 1.62∘ VS 26.6∘± 2.33∘ for the barefoot; P= 0.001), and less hallux plantarflexion during the initial stance phase (-4.86∘± 2.32∘ VS -8.68∘± 1.13∘; P< 0.001). There were also greater forefoot adduction (16.15∘± 1.37∘ VS 13.18∘± 0.79∘; P< 0.001), but no significant differences were found in forefoot abduction between the two conditions. The hind foot demonstrated a larger dorsiflexion in the horizontal plane (16.59∘± 1.69∘ VS 12.08∘± 0.9∘; P< 0.001), greater internal rotation (16.72∘± 0.48∘ VS 7.97∘± 0.55∘; P< 0.001), and decreased peak hind foot extension rotation (-5.49∘± 0.69∘ VS -10.73∘± 0.42∘; P= 0.001). These findings complement existing kinematic evidence that wearing high heels can lead to foot deformities and injuries.

Jordanian deformation of SL(2) as a contraction of its Drinfeld-Jimbo deformation

NASA Astrophysics Data System (ADS)

Aghamohammadi, A.; Khorrami, M.; Shariati, A.

1995-04-01

We show that $h$-deformation can be obtained, by a singular limit of a similarity transformation, from $q$-deformation; to be specefic, we obtain $\\GL_h(2)$, its differential structure, its inhomogenous extension, and $\\Uh{\\sl(2)}$ from their $q$-deformed counterparts.

Deformations of superconformal theories

DOE PAGES

Córdova, Clay; Dumitrescu, Thomas T.; Intriligator, Kenneth

2016-11-22

Here, we classify possible supersymmetry-preserving relevant, marginal, and irrelevant deformations of unitary superconformal theories in d ≥ 3 dimensions. Our method only relies on symmetries and unitarity. Hence, the results are model independent and do not require a Lagrangian description. Two unifying themes emerge: first, many theories admit deformations that reside in multiplets together with conserved currents. Such deformations can lead to modifications of the supersymmetry algebra by central and noncentral charges. Second, many theories with a sufficient amount of supersymmetry do not admit relevant or marginal deformations, and some admit neither. The classification is complicated by the fact thatmore » short superconformal multiplets display a rich variety of sporadic phenomena, including supersymmetric deformations that reside in the middle of a multiplet. We illustrate our results with examples in diverse dimensions. In particular, we explain how the classification of irrelevant supersymmetric deformations can be used to derive known and new constraints on moduli-space effective actions.« less

Does excessive flatfoot deformity affect function? A comparison between symptomatic and asymptomatic flatfeet using the Oxford Foot Model.

PubMed

Hösl, Matthias; Böhm, Harald; Multerer, Christel; Döderlein, Leonhard

2014-01-01

Treatment of asymptomatic flexible flatfeet is a subject of great controversy. The purpose of this study was to examine foot function during walking in symptomatic (SFF) and asymptomatic (ASFF) flexible flatfeet. Thirty-five paediatric and juvenile patients with idiopathic flexible flatfeet were recruited from an orthopaedic outpatient department (14 SFF and 21 ASFF). Eleven age-matched participants with typically developing feet served as controls (TDF). To study foot function, 3D multi-segment foot kinematics and ankle joint kinetics were captured during barefoot gait analysis. Overall, alterations in foot kinematics in flatfeet were pronounced but differences between SFF and ASFF were not observed. Largest discriminatory effects between flatfeet and TDF were noticed in reduced hindfoot dorsiflexion as well as in increased forefoot supination and abduction. Upon clinical examination, restrictions in passive dorsiflexion in ASFF and SFF were significant. During gait, the hindfoot in flatfeet (both ASFF and SFF) was more everted, but less flexible. In sagittal plane, limited hindfoot dorsiflexion of ASFF and SFF was compensated for by increased forefoot mobility and a hypermobile hallux. Concerning ankle kinetics, SFF lacked positive joint energy for propulsion while ASFF needed to absorb more negative ankle joint energy during loading response. This may risk fatigue and overuse syndrome of anterior shank muscles in ASFF. Hence, despite a lack of symptoms flatfoot deformity in ASFF affected function. Yet, contrary to what was expected, SFF did not show greater deviations in 3D foot kinematics than ASFF. Symptoms may rather depend on tissue wear and subjective pain thresholds. Copyright © 2013. Published by Elsevier B.V.

Advantages of formulating an evolution equation directly for elastic distortional deformation in finite deformation plasticity

NASA Astrophysics Data System (ADS)

Rubin, M. B.; Cardiff, P.

2017-11-01

Simo (Comput Methods Appl Mech Eng 66:199-219, 1988) proposed an evolution equation for elastic deformation together with a constitutive equation for inelastic deformation rate in plasticity. The numerical algorithm (Simo in Comput Methods Appl Mech Eng 68:1-31, 1988) for determining elastic distortional deformation was simple. However, the proposed inelastic deformation rate caused plastic compaction. The corrected formulation (Simo in Comput Methods Appl Mech Eng 99:61-112, 1992) preserves isochoric plasticity but the numerical integration algorithm is complicated and needs special methods for calculation of the exponential map of a tensor. Alternatively, an evolution equation for elastic distortional deformation can be proposed directly with a simplified constitutive equation for inelastic distortional deformation rate. This has the advantage that the physics of inelastic distortional deformation is separated from that of dilatation. The example of finite deformation J2 plasticity with linear isotropic hardening is used to demonstrate the simplicity of the numerical algorithm.

Deformations in VLBI antennas

NASA Technical Reports Server (NTRS)

Clark, T. A.; Thomsen, P.

1988-01-01

A study is presented of deformations in antennas with the emphasis on their influence on VLBI measurements. The GIFTS structural analysis program has been used to model the VLBI antenna in Fairbanks (Alaska). The report identifies key deformations and studies the effect of gravity, wind, and temperature. Estimates of expected deformations are given.

Experimental deformation of a mafic rock - interplay between fracturing, reaction and viscous deformation

NASA Astrophysics Data System (ADS)

Marti, Sina; Stünitz, Holger; Heilbronner, Renée; Plümper, Oliver; Drury, Martyn

2016-04-01

Deformation experiments were performed on natural Maryland Diabase (˜ 55% Plg, 42% Px, 3% accessories, 0.18 wt.-% H2O added) in a Griggs-type deformation apparatus in order to explore the brittle-viscous transition and the interplay between deformation and mineral reactions. Shear experiments at strain rates of ˜ 2e-5 /s are performed, at T=600, 700 and 800°C and confining pressures Pc=1.0 and 1.5 GPa. Deformation localizes in all experiments. Below 700°C, the microstructure is dominated by brittle deformation with a foliation formed by cataclastic flow and high strain accommodated along 3-5 major ultracataclasite shear bands. At 700°C, the bulk of the material still exhibits abundant microfractures, however, deformation localizes into an anastomosing network of shear bands (SB) formed from a fine-grained (<< 1 μm) mixture of newly formed Plg and Amph. These reaction products occur almost exclusively along syn-kinematic structures such as fractures and SB. Experiments at 800°C show extensive mineral reactions, with the main reaction products Amph+Plg (+Zo). Deformation is localized in broad C' and C SB formed by a fine-grained (0.1 - 0.8 μm) mixture of Plg+Amph (+Zo). The onset of mineral reactions in the 700°C experiments shows that reaction kinetics and diffusional mass transport are fast enough to keep up with the short experimental timescales. While in the 700°C experiments brittle processes kinematically contribute to deformation, fracturing is largely absent at 800°C. Diffusive mass transfer dominates. The very small grain size within SB favours a grain size sensitive deformation mechanism. Due to the presence of water (and relatively high supported stresses), dissolution-precipitation creep is interpreted to be the dominant strain accommodating mechanism. From the change of Amph coronas around Px clasts with strain, we can determine that Amph is re-dissolved at high stress sites while growing in low stress sites, showing the ability of Amph to

Osteosynthesis in situ for lateral condyle nonunion in children.

PubMed

Park, Hoon; Hwang, Jin Ho; Kwon, Yong Uk; Kim, Hyun Woo

2015-06-01

This study investigated the efficacy of osteosynthesis in situ by evaluating the functional and cosmetic results in children with nonunion of lateral condyle fractures. Sixteen consecutive patients were treated with in situ fixation consisting of minimal curettage of fracture gap and screw compression of metaphyseal fragments without bone grafting. The mean age at the time of surgery was 5.6 years (range, 1 to 10 y). The mean interval between the initial lateral condylar fracture and surgery was 4.8 months (range, 3 to 12 mo). The average amount of displacement measured on radiographs was 6.6 mm medially and 7.4 mm laterally. Outcome was assessed by clinical and radiologic evaluation at the latest follow-up. All patients achieved bony union. The mean duration of follow-up was 45.4 months (range, 24 to 67 mo). The range of motion and flexion contracture improved postoperatively in all patients. There was no evidence of premature growth arrest, osteonecrosis, or fishtail deformity until last follow-up. The overall result was excellent in 5, good in 10, and fair in 1 patient. However, 3 patients developed valgus or varus deformities of >10 degrees. Osteosynthesis in situ can be an effective and safe treatment for achieving bone union and improved elbow motion and preventing avascular necrosis. However, valgus or varus deformities may occur after this procedure and corrective osteotomy may be necessary. Level IV - case series.

Deformation of second and third quantization

NASA Astrophysics Data System (ADS)

Faizal, Mir

2015-03-01

In this paper, we will deform the second and third quantized theories by deforming the canonical commutation relations in such a way that they become consistent with the generalized uncertainty principle. Thus, we will first deform the second quantized commutator and obtain a deformed version of the Wheeler-DeWitt equation. Then we will further deform the third quantized theory by deforming the third quantized canonical commutation relation. This way we will obtain a deformed version of the third quantized theory for the multiverse.

Deformations of the Almheiri-Polchinski model

NASA Astrophysics Data System (ADS)

Kyono, Hideki; Okumura, Suguru; Yoshida, Kentaroh

2017-03-01

We study deformations of the Almheiri-Polchinski (AP) model by employing the Yang-Baxter deformation technique. The general deformed AdS2 metric becomes a solution of a deformed AP model. In particular, the dilaton potential is deformed from a simple quadratic form to a hyperbolic function-type potential similarly to integrable deformations. A specific solution is a deformed black hole solution. Because the deformation makes the spacetime structure around the boundary change drastically and a new naked singularity appears, the holographic interpretation is far from trivial. The Hawking temperature is the same as the undeformed case but the Bekenstein-Hawking entropy is modified due to the deformation. This entropy can also be reproduced by evaluating the renormalized stress tensor with an appropriate counter-term on the regularized screen close to the singularity.

SU-E-J-104: Evaluation of Accuracy for Various Deformable Image Registrations with Virtual Deformation QA Software

DOE Office of Scientific and Technical Information (OSTI.GOV)

Han, S; Kim, K; Kim, M

Purpose: The accuracy of deformable image registration (DIR) has a significant dosimetric impact in radiation treatment planning. We evaluated accuracy of various DIR algorithms using virtual deformation QA software (ImSimQA, Oncology System Limited, UK). Methods: The reference image (Iref) and volume (Vref) was first generated with IMSIMQA software. We deformed Iref with axial movement of deformation point and Vref depending on the type of deformation that are the deformation1 is to increase the Vref (relaxation) and the deformation 2 is to decrease the Vref (contraction) .The deformed image (Idef) and volume (Vdef) were inversely deformed to Iref and Vref usingmore » DIR algorithms. As a Result, we acquired deformed image (Iid) and volume (Vid). The DIR algorithms were optical flow (HS, IOF) and demons (MD, FD) of the DIRART. The image similarity evaluation between Iref and Iid was calculated by Normalized Mutual Information (NMI) and Normalized Cross Correlation (NCC). The value of Dice Similarity Coefficient (DSC) was used for evaluation of volume similarity. Results: When moving distance of deformation point was 4 mm, the value of NMI was above 1.81 and NCC was above 0.99 in all DIR algorithms. Since the degree of deformation was increased, the degree of image similarity was decreased. When the Vref increased or decreased about 12%, the difference between Vref and Vid was within ±5% regardless of the type of deformation. The value of DSC was above 0.95 in deformation1 except for the MD algorithm. In case of deformation 2, that of DSC was above 0.95 in all DIR algorithms. Conclusion: The Idef and Vdef have not been completely restored to Iref and Vref and the accuracy of DIR algorithms was different depending on the degree of deformation. Hence, the performance of DIR algorithms should be verified for the desired applications.« less

Deformation Invariant Attribute Vector for Deformable Registration of Longitudinal Brain MR Images

PubMed Central

Li, Gang; Guo, Lei; Liu, Tianming

2009-01-01

This paper presents a novel approach to define deformation invariant attribute vector (DIAV) for each voxel in 3D brain image for the purpose of anatomic correspondence detection. The DIAV method is validated by using synthesized deformation in 3D brain MRI images. Both theoretic analysis and experimental studies demonstrate that the proposed DIAV is invariant to general nonlinear deformation. Moreover, our experimental results show that the DIAV is able to capture rich anatomic information around the voxels and exhibit strong discriminative ability. The DIAV has been integrated into a deformable registration algorithm for longitudinal brain MR images, and the results on both simulated and real brain images are provided to demonstrate the good performance of the proposed registration algorithm based on matching of DIAVs. PMID:19369031

Nearly associative deformation quantization

NASA Astrophysics Data System (ADS)

Vassilevich, Dmitri; Oliveira, Fernando Martins Costa

2018-04-01

We study several classes of non-associative algebras as possible candidates for deformation quantization in the direction of a Poisson bracket that does not satisfy Jacobi identities. We show that in fact alternative deformation quantization algebras require the Jacobi identities on the Poisson bracket and, under very general assumptions, are associative. At the same time, flexible deformation quantization algebras exist for any Poisson bracket.

Distal tibial fractures are a poorly recognised complication with fibula free flaps.

PubMed

Durst, A; Clibbon, J; Davis, B

2015-09-01

The fibula free flap is ideal for complex jaw reconstructions, with low reported donor and flap morbidity. We discuss a distal tibial stress fracture two months following a vascularised fibula free flap procedure. Despite being an unrecognised complication, a literature review produced 13 previous cases; only two were reported in the reconstructive surgery literature, with the most recent claiming to be the first. The majority of these studies treated this fracture non-operatively; none reported their patient follow-up. Each case presented with ipsilateral leg pain, which has been cited as an early donor site morbidity in as many as 40% of fibula free flap cases. It is known that the fibula absorbs at least 15% of leg load on weight bearing. Studies have shown severe valgus deformities in up to 25% of patients with fibulectomies. We treated our patient operatively, first correcting his worsening valgus deformity with an external fixator, then reinforcing his healed fracture with a long distal tibial plate. We believe that this complication is underreported, unexpected and not mentioned during the consenting process. By highlighting the management of our case and the literature, we aim to increase awareness (and thus further reporting and appropriate management) of this debilitating complication.

Post Deformation at Room and Cryogenic Temperature Cooling Media on Severely Deformed 1050-Aluminum

NASA Astrophysics Data System (ADS)

Khorrami, M. Sarkari; Kazeminezhad, M.

2018-03-01

The annealed 1050-aluminum sheets were initially subjected to the severe plastic deformation through two passes of constrained groove pressing (CGP) process. The obtained specimens were post-deformed by friction stir processing at room and cryogenic temperature cooling media. The microstructure evolutions during mentioned processes in terms of grain structure, misorientation distribution, and grain orientation spread (GOS) were characterized using electron backscattered diffraction. The annealed sample contained a large number of "recrystallized" grains and relatively large fraction (78%) of high-angle grain boundaries (HAGBs). When CGP process was applied on the annealed specimen, the elongated grains with interior substructure were developed, which was responsible for the formation of 80% low-angle grain boundaries. The GOS map of the severely deformed specimen manifested the formation of 43% "distorted" and 51% "substructured" grains. The post deformation of severely deformed aluminum at room temperature led to the increase in the fraction of HAGBs from 20 to 60%. Also, it gave rise to the formation of "recrystallized" grains with the average size of 13 μm, which were coarser than the grains predicted by Zener-Hollomon parameter. This was attributed to the occurrence of appreciable grain growth during post deformation. In the case of post deformation at cryogenic temperature cooling medium, the grain size was decreased, which was in well agreement with the predicted grain size. The cumulative distribution of misorientation was the same for both processing routes. Mechanical properties characterizations in terms of nano-indentation and tensile tests revealed that the post deformation process led to the reduction in hardness, yield stress, and ultimate tensile strength of the severely deformed aluminum.

Nuclear Deformation at Finite Temperature

NASA Astrophysics Data System (ADS)

Alhassid, Y.; Gilbreth, C. N.; Bertsch, G. F.

2014-12-01

Deformation, a key concept in our understanding of heavy nuclei, is based on a mean-field description that breaks the rotational invariance of the nuclear many-body Hamiltonian. We present a method to analyze nuclear deformations at finite temperature in a framework that preserves rotational invariance. The auxiliary-field Monte Carlo method is used to generate a statistical ensemble and calculate the probability distribution associated with the quadrupole operator. Applying the technique to nuclei in the rare-earth region, we identify model-independent signatures of deformation and find that deformation effects persist to temperatures higher than the spherical-to-deformed shape phase-transition temperature of mean-field theory.

Cosmetic and Functional Nasal Deformities

MedlinePlus

... nasal complaints. Nasal deformity can be categorized as “cosmetic” or “functional.” Cosmetic deformity of the nose results in a less ... taste , nose bleeds and/or recurrent sinusitis . A cosmetic or functional nasal deformity may occur secondary to ...

Lessons learned from selective soft-tissue release for gap balancing in primary total knee arthroplasty: an analysis of 1216 consecutive total knee arthroplasties: AAOS exhibit selection.

PubMed

Peters, Christopher L; Jimenez, Chris; Erickson, Jill; Anderson, Mike B; Pelt, Christopher E

2013-10-16

Soft-tissue releases are commonly necessary to achieve symmetrical flexion and extension gaps in primary total knee arthroplasty performed with a measured resection technique. We reviewed the frequency of required releases according to preoperative alignment and the clinical and radiographic results; associations with failure, reoperations, and complications are presented. We reviewed 1216 knees that underwent primary total knee arthroplasty from 2004 to 2009; 774 (64%) were in female patients and 442 (36%), in male patients. In the coronal plane, 855 knees had preoperative varus deformity, 123 were neutral, and 238 had valgus deformity. The mean age at the time of the index procedure was 62.7 years (range, twenty-three to ninety-four years), and the mean body mass index was 32.7 kg/m² (range, 17.4 to 87.9 kg/m²). Clinical outcomes included the Knee Society Score (KSS), implant failure, reoperation, and complications. Radiographs were analyzed for component alignment. The only difference in the total KSS was found at the time of final follow-up between valgus knees with zero releases (total KSS = 178) and those with one or two releases (KSS = 160, p = 0.026). Overall, 407 knees (33.5%) required zero releases, 686 (56.4%) required one or two releases, and 123 (10.1%) required three or more releases. Among varus knees, 37% required zero releases, 55% required one or two releases, and 7.5% required three or more releases. Among neutral knees, 39% required zero releases, 55% required one or two releases, and 5.7% required three or more releases. Only 17% of valgus knees required zero releases whereas 61% required one or two releases and 21.8% required three or more releases. Valgus knees required more releases than neutral or varus knees did (p < 0.001). Selective soft-tissue release for gap balancing in primary total knee arthroplasty is an effective technique that produced excellent clinical and radiographic results regardless of preoperative alignment. Consistent

Ankle joint pressure changes in high tibial and distal femoral osteotomies: a cadaver study.

PubMed

Krause, F; Barandun, A; Klammer, G; Zderic, I; Gueorguiev, B; Schmid, T

2017-01-01

To assess the effect of high tibial and distal femoral osteotomies (HTO and DFO) on the pressure characteristics of the ankle joint. Varus and valgus malalignment of the knee was simulated in human cadaver full-length legs. Testing included four measurements: baseline malalignment, 5° and 10° re-aligning osteotomy, and control baseline malalignment. For HTO, testing was rerun with the subtalar joint fixed. In order to represent half body weight, a 300 N force was applied onto the femoral head. Intra-articular sensors captured ankle pressure. In the absence of restriction of subtalar movement, insignificant migration of the centre of force and changes of maximal pressure were seen at the ankle joint. With restricted subtalar motion, more significant lateralisation of the centre of force were seen with the subtalar joint in varus than in valgus position. Changes in maximum pressure were again not significant. The re-alignment of coronal plane knee deformities by HTO and DFO altered ankle pressure characteristics. When the subtalar joint was fixed in the varus position, migration of centre of force after HTO was more significant than when the subtalar joint was fixed in valgus. Cite this article: Bone Joint J 2017;99-B:59-65. ©2017 The British Editorial Society of Bone & Joint Surgery.

[Lateral column lengthening osteotomy of calcaneus].

PubMed

Hintermann, B

2015-08-01

Lengthening of the lateral column for adduction of forefoot and restoration of the medial arch. Stabilization of the ankle joint complex. Supple flatfoot deformity (posterior tibial tendon dysfunction stage II). Instability of the medial ankle joint complex (superficial deltoid and spring ligament). Posttraumatic valgus and pronation deformity of the foot. Rigid flatfoot deformity (posterior tibial tendon dysfunction stage III and IV). Talocalcaneal and naviculocalcaneal coalition. Osteoarthritis of calcaneocuboid joint. Exposition of calcaneus at sinus tarsi. Osteotomy through sinus tarsi and widening until desired correction of the foot is achieved. Insertion of bone graft. Screw fixation. Immobilization in a cast for 6 weeks. Weight-bearing as tolerated from the beginning. In the majority of cases, part of hindfoot reconstruction. Reliable and stable correction. Safe procedure with few complications.

Deformation of crowns during cementation.

PubMed

Wilson, P R; Goodkind, R J; Delong, R; Sakaguchi, R

1990-11-01

Deformation of crowns during cementation was investigated by a simple loading system of defined crowns with silicone fluids as cements. Deformation of the crowns was measured by long stain gauges that encircled the cervical margins. Die spacing was simulated by etching the die. Venting was simulated by removing a small screw. Deformation of the crowns was decreased by decreasing the viscosity of fluid, increasing the thickness of the crowns, and venting. Etching the die decreased the seating times of the crowns, but did not alter the level of deformation. Terminal cementation with zinc phosphate cement confirmed the presence of crown deformation during cementation. The results have consequences for bonded and all-ceramic crowns, and explain several clinical phenomena. It is suggested that low viscosity cements, low seating forces, and die spacing be used to decrease the deformation of crowns during seating. The importance of passive fitting of the crown to the tooth is stressed.

Dealing with difficult deformations: construction of a knowledge-based deformation atlas

NASA Astrophysics Data System (ADS)

Thorup, S. S.; Darvann, T. A.; Hermann, N. V.; Larsen, P.; Ólafsdóttir, H.; Paulsen, R. R.; Kane, A. A.; Govier, D.; Lo, L.-J.; Kreiborg, S.; Larsen, R.

2010-03-01

Twenty-three Taiwanese infants with unilateral cleft lip and palate (UCLP) were CT-scanned before lip repair at the age of 3 months, and again after lip repair at the age of 12 months. In order to evaluate the surgical result, detailed point correspondence between pre- and post-surgical images was needed. We have previously demonstrated that non-rigid registration using B-splines is able to provide automated determination of point correspondences in populations of infants without cleft lip. However, this type of registration fails when applied to the task of determining the complex deformation from before to after lip closure in infants with UCLP. The purpose of the present work was to show that use of prior information about typical deformations due to lip closure, through the construction of a knowledge-based atlas of deformations, could overcome the problem. Initially, mean volumes (atlases) for the pre- and post-surgical populations, respectively, were automatically constructed by non-rigid registration. An expert placed corresponding landmarks in the cleft area in the two atlases; this provided prior information used to build a knowledge-based deformation atlas. We model the change from pre- to post-surgery using thin-plate spline warping. The registration results are convincing and represent a first move towards an automatic registration method for dealing with difficult deformations due to this type of surgery.

Foldover-free shape deformation for biomedicine.

PubMed

Yu, Hongchuan; Zhang, Jian J; Lee, Tong-Yee

2014-04-01

Shape deformation as a fundamental geometric operation underpins a wide range of applications, from geometric modelling, medical imaging to biomechanics. In medical imaging, for example, to quantify the difference between two corresponding images, 2D or 3D, one needs to find the deformation between both images. However, such deformations, particularly deforming complex volume datasets, are prone to the problem of foldover, i.e. during deformation, the required property of one-to-one mapping no longer holds for some points. Despite numerous research efforts, the construction of a mathematically robust foldover-free solution subject to positional constraints remains open. In this paper, we address this challenge by developing a radial basis function-based deformation method. In particular we formulate an effective iterative mechanism which ensures the foldover-free property is satisfied all the time. The experimental results suggest that the resulting deformations meet the internal positional constraints. In addition to radial basis functions, this iterative mechanism can also be incorporated into other deformation approaches, e.g. B-spline based FFDs, to develop different deformable approaches for various applications. Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

Management of Congenital Chest Wall Deformities

PubMed Central

Blanco, Felix C.; Elliott, Steven T.; Sandler, Anthony D.

2011-01-01

Congenital chest wall deformities are considered to be anomalies in chest wall growth. These can be categorized as either rib cage overgrowth or deformities related to inadequate growth (aplasia or dysplasia). Rib cage overgrowth leads to depression of the sternum (pectus excavatum) or protuberance of the sternum (pectus carinatum) and accounts for greater than 90% of congenital chest wall deformities. The remaining deformities are a result of inadequate growth. Evolution in the management of congenital chest wall deformities has made significant progress over the past 25 years. This article will review chest wall deformities and the current management strategies of these interesting anomalies. PMID:22294949

Interfacial Bubble Deformations

NASA Astrophysics Data System (ADS)

Seymour, Brian; Shabane, Parvis; Cypull, Olivia; Cheng, Shengfeng; Feitosa, Klebert

Soap bubbles floating at an air-water experience deformations as a result of surface tension and hydrostatic forces. In this experiment, we investigate the nature of such deformations by taking cross-sectional images of bubbles of different volumes. The results show that as their volume increases, bubbles transition from spherical to hemispherical shape. The deformation of the interface also changes with bubble volume with the capillary rise converging to the capillary length as volume increases. The profile of the top and bottom of the bubble and the capillary rise are completely determined by the volume and pressure differences. James Madison University Department of Physics and Astronomy, 4VA Consortium, Research Corporation for Advancement of Science.

Deformation-induced crystallographic-preferred orientation of hcp-iron: An experimental study using a deformation-DIA apparatus

NASA Astrophysics Data System (ADS)

Nishihara, Yu; Ohuchi, Tomohiro; Kawazoe, Takaaki; Seto, Yusuke; Maruyama, Genta; Higo, Yuji; Funakoshi, Ken-ichi; Tange, Yoshinori; Irifune, Tetsuo

2018-05-01

Shear and uniaxial deformation experiments on hexagonal close-packed iron (hcp-Fe) was conducted using a deformation-DIA apparatus at a pressure of 13-17 GPa and a temperature of 723 K to determine its deformation-induced crystallographic-preferred orientation (CPO). Development of the CPO in the deforming sample is determined in-situ based on two-dimensional X-ray diffraction using monochromatic synchrotron X-rays. In the shear deformation geometry, the <0001> and < 11 2 bar 0 > axes gradually align to be sub-parallel to the shear plane normal and shear direction, respectively, from the initial random texture. In the uniaxial compression and tensile geometry, the <0001> and < 11 2 bar 0 > axes, respectively, gradually align along the direction of the uniaxial deformation axis. These results suggest that basal slip (0001) < 11 2 bar 0 > is the dominant slip system in hcp-Fe under the studied deformation conditions. The P-wave anisotropy for a shear deformed sample was calculated using elastic constants at the inner core condition by recent ab-initio calculations. Strength of the calculated anisotropy was comparable to or higher than axisymmetric anisotropy in Earth's inner core.

Late-Paleozoic-Mesozoic deformational and deformation related metamorphic structures of Kuznetsk-Altai region

NASA Astrophysics Data System (ADS)

Zinoviev, Sergei

2014-05-01

Kuznetsk-Altai region is a part of the Central Asian Orogenic Belt. The nature and formation mechanisms of the observed structure of Kuznetsk-Altai region are interpreted by the author as the consequence of convergence of Tuva-Mongolian and Junggar lithospheric block structures and energy of collision interaction between the blocks of crust in Late-Paleozoic-Mesozoic period. Tectonic zoning of Kuznetsk-Altai region is based on the principle of adequate description of geological medium (without methods of 'primary' state recovery). The initial indication of this convergence is the crust thickening in the zone of collision. On the surface the mechanisms of lateral compression form a regional elevation; with this elevation growth the 'mountain roots' start growing. With an approach of blocks an interblock elevation is divided into various fragments, and these fragments interact in the manner of collision. The physical expression of collision mechanisms are periodic pulses of seismic activity. The main tectonic consequence of the block convergence and collision of interblock units is formation of an ensemble of regional structures of the deformation type on the basis of previous 'pre-collision' geological substratum [Chikov et al., 2012]. This ensemble includes: 1) allochthonous and autochthonous blocks of weakly deformed substratum; 2) folded (folded-thrust) systems; 3) dynamic metamorphism zones of regional shears and main faults. Characteristic of the main structures includes: the position of sedimentary, magmatic and PT-metamorphic rocks, the degree of rock dynamometamorphism and variety rock body deformation, as well as the styles and concentrations of mechanic deformations. 1) block terranes have weakly elongated or isometric shape in plane, and they are the systems of block structures of pre-collision substratum separated by the younger zones of interblock deformations. They stand out among the main deformation systems, and the smallest are included into the

Homogeneous Yang-Baxter deformations as generalized diffeomorphisms

NASA Astrophysics Data System (ADS)

Sakamoto, Jun-ichi; Sakatani, Yuho; Yoshida, Kentaroh

2017-10-01

Yang-Baxter (YB) deformations of string sigma model provide deformed target spaces. We propose that homogeneous YB deformations always lead to a certain class of β-twisted backgrounds and represent the bosonic part of the supergravity fields in terms of the classical r-matrix associated with the YB deformation. We then show that various β-twisted backgrounds can be realized by considering generalized diffeomorphisms in the undeformed background. Our result extends the notable relation between the YB deformations and (non-commuting) TsT transformations. We also discuss more general deformations beyond the YB deformations.

Deformation twinning: Influence of strain rate

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gray, G.T. III

Twins in most crystal structures, including advanced materials such as intermetallics, form more readily as the temperature of deformation is decreased or the rate of deformation is increased. Both parameters lead to the suppression of thermally-activated dislocation processes which can result in stresses high enough to nucleate and grow deformation twins. Under high-strain rate or shock-loading/impact conditions deformation twinning is observed to be promoted even in high stacking fault energy FCC metals and alloys, composites, and ordered intermetallics which normally do not readily deform via twinning. Under such conditions and in particular under the extreme loading rates typical of shockmore » wave deformation the competition between slip and deformation twinning can be examined in detail. In this paper, examples of deformation twinning in the intermetallics TiAl, Ti-48Al-lV and Ni{sub 3}A as well in the cermet Al-B{sub 4}C as a function of strain rate will be presented. Discussion includes: (1) the microstructural and experimental variables influencing twin formation in these systems and twinning topics related to high-strain-rate loading, (2) the high velocity of twin formation, and (3) the influence of deformation twinning on the constitutive response of advanced materials.« less

Polygonal deformation bands in sandstone

NASA Astrophysics Data System (ADS)

Antonellini, Marco; Nella Mollema, Pauline

2017-04-01

We report for the first time the occurrence of polygonal faults in sandstone, which is compelling given that layer-bound polygonal fault systems have been observed so far only in fine-grained sediments such as clay and chalk. The polygonal faults are dm-wide zones of shear deformation bands that developed under shallow burial conditions in the lower portion of the Jurassic Entrada Fm (Utah, USA). The edges of the polygons are 1 to 5 meters long. The shear deformation bands are organized as conjugate faults along each edge of the polygon and form characteristic horst-like structures. The individual deformation bands have slip magnitudes ranging from a few mm to 1.5 cm; the cumulative average slip magnitude in a zone is up to 10 cm. The deformation bands heaves, in aggregate form, accommodate a small isotropic horizontal extension (strain < 0.005). The individual shear deformation bands show abutting T-junctions, veering, curving, and merging where they mechanically interact. Crosscutting relationships are rare. The interactions of the deformation bands are similar to those of mode I opening fractures. Density inversion, that takes place where under-compacted and over-pressurized layers (Carmel Fm) lay below normally compacted sediments (Entrada Sandstone), may be an important process for polygonal deformation bands formation. The gravitational sliding and soft sediment structures typically observed within the Carmel Fm support this hypothesis. Soft sediment deformation may induce polygonal faulting in the section of the Entrada Sandstone just above the Carmel Fm. The permeability of the polygonal deformation bands is approximately 10-14 to 10-13 m2, which is less than the permeability of the host, Entrada Sandstone (range 10-12 to 10-11 m2). The documented fault networks have important implications for evaluating the geometry of km-scale polygonal fault systems in the subsurface, top seal integrity, as well as constraining paleo-tectonic stress regimes.

Occurrence of oral deformities in larval anurans

USGS Publications Warehouse

Drake, D.L.; Altig, R.; Grace, J.B.; Walls, S.C.

2007-01-01

We quantified deformities in the marginal papillae, tooth rows, and jaw sheaths of tadpoles from 13 population samples representing three families and 11 sites in the southeastern United States. Oral deformities were observed in all samples and in 13.5-98% of the specimens per sample. Batrachochytrium dendrobatidis (chytrid) infections were detected in three samples. There was high variability among samples in the pattern and number of discovered deformities. Pairwise associations between oral structures containing deformities were nonrandom for several populations, especially those with B. dendrobatidis infections or high total numbers of deformities. Comparisons of deformities among samples using multivariate analyses revealed that tadpole samples grouped together by family. Analyses of ordination indicated that three variables, the number of deformities, the number of significant associations among deformity types within populations, and whether populations were infected with B. dendrobatidis, were significantly correlated with the pattern of deformities. Our data indicate that the incidence of oral deformities can be high in natural populations and that phylogeny and B. dendrobatidis infection exert a strong influence on the occurrence and type of oral deformities in tadpoles. ?? by the American Society of Ichthyologists and Herperologists.

Satisfactory Short-Term Results of Navigation-Assisted Gap-Balancing Total Knee Arthroplasty Using Ultracongruent Insert.

PubMed

Yoon, Jung-Ro; Yang, Jae-Hyuk

2018-03-01

The use of highly conforming ultracongruent (UC) polyethylene insert is bone-preserving and became a relatively common alternative to the conventional posterior stabilized total knee arthroplasty (TKA) design. The purpose of this study was to analyze the short-term clinical and radiologic results of UC insert TKA using the navigation-assisted gap-balancing technique. Two hundred thirty-three knees were operated with a mean follow-up period of 8.1 years (minimum of 5 years). Radiologic and clinical outcomes were assessed before operation and at latest follow-up using the Knee Society Score and Western Ontario and McMaster Universities Osteoarthritis Index score. For statistical analysis, paired sample t-test and analysis of variance were used. Significance was considered as P < .05. According to the preoperative deformities (valgus, mild varus, and moderate varus), there were 23 cases (9.9%) of valgus deformity, 180 cases (77.3%) of mild varus deformity, and 30 cases (12.9%) of moderate varus deformity. Overall, the results at mean 8.1 years revealed an improvement in mean Knee Society Score (54 ± 12 to 92 ± 3) and mean Western Ontario and McMaster Universities Osteoarthritis Index scores (62 ± 14 to 17 ± 3). Overall, 220 of 233 cases (94.4%) were in neutral alignment (between -3° and +3°) at latest follow-up. There were no migrating or shifting prosthesis that should be considered as possible failure. There was 0% component revision rate. Navigation-assisted gap-balancing technique using UC insert TKA had satisfactory short-term outcome. Strict gap-balancing technique using the offset-type-force-controlled-spreader-system aided in the satisfactory results. Copyright © 2017 Elsevier Inc. All rights reserved.

Behavior of lateral-deformation coefficients during elastoplastic deformation of metals

NASA Astrophysics Data System (ADS)

Zimin, B. A.; Smirnov, I. V.; Sudenkov, Yu. V.

2017-06-01

The results of investigations into variation of the coefficients of lateral deformation (the Poisson ratio) during single-axis tension of samples of steel 12Kh18N10T and St3, titanium VT1, the aluminum alloy D16AM, copper M1, and a magnesium alloy are considered. The technique developed on the basis of the optoacoustic effect and simultaneous measurements of the longitudinal and surface speeds of sound in metallic samples during the tension makes it possible to measure the rates at various stages of the deformation process. The data obtained make it possible to construct the dependences of variation of the lateral-deformation coefficients at all stages of the plastic flow. The correlation of these variations both with known processes of structural reconstructions at various stages of plastic flow and with the process of localization of plastic-shear bands in the aluminum alloy is noted.

Deformation-Aware Log-Linear Models

NASA Astrophysics Data System (ADS)

Gass, Tobias; Deselaers, Thomas; Ney, Hermann

In this paper, we present a novel deformation-aware discriminative model for handwritten digit recognition. Unlike previous approaches our model directly considers image deformations and allows discriminative training of all parameters, including those accounting for non-linear transformations of the image. This is achieved by extending a log-linear framework to incorporate a latent deformation variable. The resulting model has an order of magnitude less parameters than competing approaches to handling image deformations. We tune and evaluate our approach on the USPS task and show its generalization capabilities by applying the tuned model to the MNIST task. We gain interesting insights and achieve highly competitive results on both tasks.

Non-affine deformations in polymer hydrogels

PubMed Central

Wen, Qi; Basu, Anindita; Janmey, Paul A.; Yodh, A. G.

2012-01-01

Most theories of soft matter elasticity assume that the local strain in a sample after deformation is identical everywhere and equal to the macroscopic strain, or equivalently that the deformation is affine. We discuss the elasticity of hydrogels of crosslinked polymers with special attention to affine and non-affine theories of elasticity. Experimental procedures to measure non-affine deformations are also described. Entropic theories, which account for gel elasticity based on stretching out individual polymer chains, predict affine deformations. In contrast, simulations of network deformation that result in bending of the stiff constituent filaments generally predict non-affine behavior. Results from experiments show significant non-affine deformation in hydrogels even when they are formed by flexible polymers for which bending would appear to be negligible compared to stretching. However, this finding is not necessarily an experimental proof of the non-affine model for elasticity. We emphasize the insights gained from experiments using confocal rheoscope and show that, in addition to filament bending, sample micro-inhomogeneity can be a significant alternative source of non-affine deformation. PMID:23002395

Estimation of the genetic correlations between twisted legs and growth or conformation traits in broiler chickens.

PubMed

Bihan-Duval, E L; Beaumont, C; Colleau, J J

1997-01-12

Genetic correlations between two types of leg deformities, valgus and varus angulations, and some growth or conformation traits were estimated in two commercial broiler strains. 14 264 chickens of both sexes in line A were measured for leg defects at 6 weeks and body weight at 3 (BW3) or 6 (BW6) weeks. The same measures were taken in line B on 8 164 chickens, as well as breast angle (BRA) and breast meat yield (BRM) at 6 weeks on 70% of the male birds. The multinomial logit model previously developed for the genetic analysis of valgus and varus deformities was extended to deal with the joint analysis of one unordered categorical trait and one continuous variable. The model assumed a competition between latent susceptibility variates related to the various deformities and linearly dependent on the continuous performances. Location parameters for latent susceptibilities and continuous trait were estimated by the 'Maximum A Posteriori' approach and dispersion parameters by the 'Maximum Marginal Likelihood' using a tilda-hat approximation. The genetic model took into account the effects of the sire, maternal grandsire and dam within maternal grandsire. As described in a previous study, leg deformities showed moderate heritabilities. Mean heritability estimate for both lines, based on the sire/maternal-grandsire (S/MGS) component, was equal to 0.22 for valgus and varus; when based on the dam component, mean estimates were equal to 0.37 and 0.29 for the two deformities respectively. Except for BRA, heritability of growth and conformation traits appeared to be smaller when based on S/MGS component (from 0.18 to 0.47) than on dam component (from 0.41 to 0.63). Very low genetic correlations were found between susceptibilities to leg deformities and growth performances: average estimates for both lines of the genetic correlation with BW3 were -0.03 and -0.05 for valgus and varus respectively. Respective genetic correlations with BW6 were estimated to be +0.05 and +0

Quantifying the Erlenmeyer flask deformity

PubMed Central

Carter, A; Rajan, P S; Deegan, P; Cox, T M; Bearcroft, P

2012-01-01

Objective Erlenmeyer flask deformity is a common radiological finding in patients with Gaucher′s disease; however, no definition of this deformity exists and the reported prevalence of the deformity varies widely. To devise an easily applied definition of this deformity, we investigated a cohort of knee radiographs in which there was consensus between three experienced radiologists as to the presence or absence of Erlenmeyer flask morphology. Methods Using the presence or absence of Erlenmeyer flask morphology as a benchmark, we measured the diameter of the femur at the level of the physeal scar and serially at defined intervals along the metadiaphysis. Results A measured ratio in excess of 0.57 between the diameter of the femoral shaft 4 cm from the physis to the diameter of the physeal baseline itself on a frontal radiograph of the knee predicted the Erlenmeyer flask deformity with 95.6% sensitivity and 100% specificity in our series of 43 independently diagnosed adults with Gaucher′s disease. Application of this method to the distal femur detected the Erlenmeyer flask deformity reproducibly and was simple to carry out. Conclusion Unlike diagnostic assignments based on subjective review, our simple procedure for identifying the modelling deformity is based on robust quantitative measurement: it should facilitate comparative studies between different groups of patients, and may allow more rigorous exploration of the pathogenesis of the complex osseous manifestations of Gaucher′s disease to be undertaken. PMID:22010032

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.

Slow deformation of intervertebral discs.

PubMed

Broberg, K B

1993-01-01

Intervertebral discs exhibit pronounced time-dependent deformations when subjected to load variations. These deformations are caused by fluid flow to and from the disc and by viscoelastic deformation of annulus fibres. The fluid flow is caused by differences between mechanical and osmotic pressure. A mechanical model of lumbar disc functions allows one to calculate both the extent of fluid flow and its implications for disc height as well as the role played by viscoelastic deformation of annulus fibres. From such calculations changes in body height are estimated. Experimental results already documented in the literature offer bases for the determination of the parameters involved. Body height variations are studied, both those related to normal diurnal rhythmicity and those related to somewhat exceptional circumstances. The normal diurnal fluid flow is found to be about +/- 40% of the disc fluid content late in the evening. Viscoelastic deformation of annulus fibres contributes approximately one quarter of the height change obtained after several hours normal activity, but dominates during the first hour.

Patterns of Alloy Deformation by Pulsed Pressure

NASA Astrophysics Data System (ADS)

Chebotnyagin, L. M.; Potapov, V. V.; Lopatin, V. V.

2015-06-01

Patterns of alloy deformation for optimization of a welding regime are studied by the method of modeling and deformation profiles providing high deformation quality are determined. A model of stepwise kinetics of the alloy deformation by pulsed pressure from the expanding plasma channel inside of a deformable cylinder is suggested. The model is based on the analogy between the acoustic and electromagnetic wave processes in long lines. The shock wave pattern of alloy deformation in the presence of multiple reflections of pulsed pressure waves in the gap plasma channel - cylinder wall and the influence of unloading waves from free surfaces are confirmed.

Developing a Virtual Rock Deformation Laboratory

NASA Astrophysics Data System (ADS)

Zhu, W.; Ougier-simonin, A.; Lisabeth, H. P.; Banker, J. S.

2012-12-01

Experimental rock physics plays an important role in advancing earthquake research. Despite its importance in geophysics, reservoir engineering, waste deposits and energy resources, most geology departments in U.S. universities don't have rock deformation facilities. A virtual deformation laboratory can serve as an efficient tool to help geology students naturally and internationally learn about rock deformation. Working with computer science engineers, we built a virtual deformation laboratory that aims at fostering user interaction to facilitate classroom and outreach teaching and learning. The virtual lab is built to center around a triaxial deformation apparatus in which laboratory measurements of mechanical and transport properties such as stress, axial and radial strains, acoustic emission activities, wave velocities, and permeability are demonstrated. A student user can create her avatar to enter the virtual lab. In the virtual lab, the avatar can browse and choose among various rock samples, determine the testing conditions (pressure, temperature, strain rate, loading paths), then operate the virtual deformation machine to observe how deformation changes physical properties of rocks. Actual experimental results on the mechanical, frictional, sonic, acoustic and transport properties of different rocks at different conditions are compiled. The data acquisition system in the virtual lab is linked to the complied experimental data. Structural and microstructural images of deformed rocks are up-loaded and linked to different deformation tests. The integration of the microstructural image and the deformation data allows the student to visualize how forces reshape the structure of the rock and change the physical properties. The virtual lab is built using the Game Engine. The geological background, outstanding questions related to the geological environment, and physical and mechanical concepts associated with the problem will be illustrated on the web portal. In

Deformable mirrors development program at ESO

NASA Astrophysics Data System (ADS)

Stroebele, Stefan; Vernet, Elise; Brinkmann, Martin; Jakob, Gerd; Lilley, Paul; Casali, Mark; Madec, Pierre-Yves; Kasper, Markus

2016-07-01

Over the last decade, adaptive optics has become essential in different fields of research including medicine and industrial applications. With this new need, the market of deformable mirrors has expanded a lot allowing new technologies and actuation principles to be developed. Several E-ELT instruments have identified the need for post focal deformable mirrors but with the increasing size of the telescopes the requirements on the deformable mirrors become more demanding. A simple scaling up of existing technologies from few hundred actuators to thousands of actuators will not be sufficient to satisfy the future needs of ESO. To bridge the gap between available deformable mirrors and the future needs for the E-ELT, ESO started a development program for deformable mirror technologies. The requirements and the path to get the deformable mirrors for post focal adaptive optics systems for the E-ELT is presented.

Variable focal length deformable mirror

DOEpatents

Headley, Daniel [Albuquerque, NM; Ramsey, Marc [Albuquerque, NM; Schwarz, Jens [Albuquerque, NM

2007-06-12

A variable focal length deformable mirror has an inner ring and an outer ring that simply support and push axially on opposite sides of a mirror plate. The resulting variable clamping force deforms the mirror plate to provide a parabolic mirror shape. The rings are parallel planar sections of a single paraboloid and can provide an on-axis focus, if the rings are circular, or an off-axis focus, if the rings are elliptical. The focal length of the deformable mirror can be varied by changing the variable clamping force. The deformable mirror can generally be used in any application requiring the focusing or defocusing of light, including with both coherent and incoherent light sources.

Intraplate deformation due to continental collisions: A numerical study of deformation in a thin viscous sheet

NASA Technical Reports Server (NTRS)

Cohen, S. C.; Morgan, R. C.

1985-01-01

A model of crustal deformation from continental collision that involves the penetration of a rigid punch into a deformable sheet is investigated. A linear viscous flow law is used to compute the magnitude and rate of change of crustal thickness, the velocity of mass points, strain rates and their principal axes, modes of deformation, areal changes, and stress. In general, a free lateral boundary reduces the magnitude of changes in crustal thickening by allowing material to more readily escape the advancing punch. The shearing that occurs diagonally in front of the punch terminates in compression or extension depending on whether the lateral boundary is fixed or free. When the ratio of the diameter of the punch to that of the sheet exceeds one-third, the deformation is insenstive to the choice of lateral boundary conditions. When the punch is rigid with sharply defined edges, deformation is concentrated near the punch corners. With non-rigid punches, shearing results in deformation being concentrated near the center of the punch. Variations with respect to linearity and nonlinearity of flow are discussed.

Cooperative deformations of periodically patterned hydrogels.

PubMed

Wang, Zhi Jian; Zhu, Chao Nan; Hong, Wei; Wu, Zi Liang; Zheng, Qiang

2017-09-01

Nature has shown elegant paradigms of smart deformation, which inspired biomimetic systems with controllable bending, folding, and twisting that are significant for the development of soft electronics and actuators. Complex deformations are usually realized by additively incorporating typical structures in selective domains with little interaction. We demonstrate the cooperative deformations of periodically patterned hydrogel sheets, in which neighboring domains mutually interact and cooperatively deform. Nonswelling disc gels are periodically positioned in a high-swelling gel. During the swelling process, the compartmentalized high-swelling gel alternately bends upward or downward to relieve the in-plane compression, but the overall integrated structure remains flat. The synergy between the elastic mismatch and the geometric periodicity selects the outcome pattern. Both experiment and modeling show that various types of cooperative deformation can be achieved by tuning the pattern geometry and gel properties. Different responsive polymers can also be patterned in one composite gel. Under stimulation, reversible transformations between different cooperative deformations are realized. The principle of cooperative deformation should be applicable to other materials, and the patterns can be miniaturized to the micrometer- or nanometer-scale level, providing the morphing materials with advanced functionalities for applications in various fields.

Perceptual transparency from image deformation.

PubMed

Kawabe, Takahiro; Maruya, Kazushi; Nishida, Shin'ya

2015-08-18

Human vision has a remarkable ability to perceive two layers at the same retinal locations, a transparent layer in front of a background surface. Critical image cues to perceptual transparency, studied extensively in the past, are changes in luminance or color that could be caused by light absorptions and reflections by the front layer, but such image changes may not be clearly visible when the front layer consists of a pure transparent material such as water. Our daily experiences with transparent materials of this kind suggest that an alternative potential cue of visual transparency is image deformations of a background pattern caused by light refraction. Although previous studies have indicated that these image deformations, at least static ones, play little role in perceptual transparency, here we show that dynamic image deformations of the background pattern, which could be produced by light refraction on a moving liquid's surface, can produce a vivid impression of a transparent liquid layer without the aid of any other visual cues as to the presence of a transparent layer. Furthermore, a transparent liquid layer perceptually emerges even from a randomly generated dynamic image deformation as long as it is similar to real liquid deformations in its spatiotemporal frequency profile. Our findings indicate that the brain can perceptually infer the presence of "invisible" transparent liquids by analyzing the spatiotemporal structure of dynamic image deformation, for which it uses a relatively simple computation that does not require high-level knowledge about the detailed physics of liquid deformation.

Unclassified congenital deformities of the external ear.

PubMed

Vathulya, Madhubari

2018-01-01

Congenital ear deformities are a common entity. They are found in isolation or as a part of syndrome in patients. They may involve the external, middle or inner ear or in any of these combinations. Three patients of different ages presented with deformities including mirror image duplication of the superior auricle, unclassified deformities of ear lobule (wavy lobule) and deformity of superior auricle with unclassified variety of lateral ear pit. This article highlights that there are further cases of ear deformities that are noticed in the general population who come for cosmetic correction, and hence, there is a need for further modifying the classification of ear deformities.

Deforming regular black holes

NASA Astrophysics Data System (ADS)

Neves, J. C. S.

2017-06-01

In this work, we have deformed regular black holes which possess a general mass term described by a function which generalizes the Bardeen and Hayward mass functions. By using linear constraints in the energy-momentum tensor to generate metrics, the solutions presented in this work are either regular or singular. That is, within this approach, it is possible to generate regular or singular black holes from regular or singular black holes. Moreover, contrary to the Bardeen and Hayward regular solutions, the deformed regular black holes may violate the weak energy condition despite the presence of the spherical symmetry. Some comments on accretion of deformed black holes in cosmological scenarios are made.

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.

Static response of deformable microchannels

NASA Astrophysics Data System (ADS)

Christov, Ivan C.; Sidhore, Tanmay C.

2017-11-01

Microfluidic channels manufactured from PDMS are a key component of lab-on-a-chip devices. Experimentally, rectangular microchannels are found to deform into a non-rectangular cross-section due to fluid-structure interactions. Deformation affects the flow profile, which results in a nonlinear relationship between the volumetric flow rate and the pressure drop. We develop a framework, within the lubrication approximation (l >> w >> h), to self-consistently derive flow rate-pressure drop relations. Emphasis is placed on handling different types of elastic response: from pure plate-bending, to half-space deformation, to membrane stretching. The ``simplest'' model (Stokes flow in a 3D rectangular channel capped with a linearly elastic Kirchhoff-Love plate) agrees well with recent experiments. We also simulate the static response of such microfluidic channels under laminar flow conditions using ANSYSWorkbench. Simulations are calibrated using experimental flow rate-pressure drop data from the literature. The simulations provide highly resolved deformation profiles, which are difficult to measure experimentally. By comparing simulations, experiments and our theoretical models, we show good agreement in many flow/deformation regimes, without any fitting parameters.

Quantifying torso deformity in scoliosis

NASA Astrophysics Data System (ADS)

Ajemba, Peter O.; Kumar, Anish; Durdle, Nelson G.; Raso, V. James

2006-03-01

Scoliosis affects the alignment of the spine and the shape of the torso. Most scoliosis patients and their families are more concerned about the effect of scoliosis on the torso than its effect on the spine. There is a need to develop robust techniques for quantifying torso deformity based on full torso scans. In this paper, deformation indices obtained from orthogonal maps of full torso scans are used to quantify torso deformity in scoliosis. 'Orthogonal maps' are obtained by applying orthogonal transforms to 3D surface maps. (An 'orthogonal transform' maps a cylindrical coordinate system to a Cartesian coordinate system.) The technique was tested on 361 deformed computer models of the human torso and on 22 scans of volunteers (8 normal and 14 scoliosis). Deformation indices from the orthogonal maps correctly classified up to 95% of the volunteers with a specificity of 1.00 and a sensitivity of 0.91. In addition to classifying scoliosis, the system gives a visual representation of the entire torso in one view and is viable for use in a clinical environment for managing scoliosis.

Volcanic deformation in the Andes

NASA Astrophysics Data System (ADS)

Riddick, S.; Fournier, T.; Pritchard, M.

2009-05-01

We present the results from an InSAR survey of volcanic activity in South America. We use data from the Japanese Space Agency's ALOS L-band radar satellite from 2006-2009. The L-band instrument provides better coherence in densely vegetated regions, compared to the shorter wave length C-band data. The survey reveals volcano related deformation in regions, north, central and southern, of the Andes volcanic arc. Since observations are limited to the austral summer, comprehensive coverage of all volcanoes is not possible. Yet, our combined observations reveal volcanic/hydrothermal deformation at Lonquimay, Llaima, Laguna del Maule, and Chaitén volcanoes, extend deformation measurements at Copahue, and illustrate temporal complexity to the previously described deformation at Cerro Hudson and Cordón Caulle. No precursory deformation is apparent before the large Chaitén eruption (VEI_5) of 2 May 2008, (at least before 16 April) suggesting rapid magma movement from depth at this long dormant volcano. Subsidence at Ticsani Volcano occurred coincident with an earthquake swarm in the same region.

State-variable theories for nonelastic deformation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, C.Y.

The various concepts of mechanical equation of state for nonelastic deformation in crystalline solids, originally proposed for plastic deformation, have been recently extended to describe additional phenomena such as anelastic and microplastic deformation including the Bauschinger effect. It has been demonstrated that it is possible to predict, based on current state variables in a unified way, the mechanical response of a material under an arbitrary loading. Thus, if the evolution laws of the state variables are known, one can describe the behavior of a material for a thermal-mechanical path of interest, for example, during constant load (or stress) creep withoutmore » relying on specialized theories. Some of the existing theories of mechanical equation of state for nonelastic deformation are reviewed. The establishment of useful forms of mechanical equation of state has to depend on extensive experimentation in the same way as that involved in the development, for example, the ideal gas law. Recent experimental efforts are also reviewed. It has been possible to develop state-variable deformation models based on experimental findings and apply them to creep, cyclic deformation, and other time-dependent deformation. Attempts are being made to correlate the material parameters of the state-variable models with the microstructure of a material. 24 figures.« less

Physics-based deformable organisms for medical image analysis

NASA Astrophysics Data System (ADS)

Hamarneh, Ghassan; McIntosh, Chris

2005-04-01

Previously, "Deformable organisms" were introduced as a novel paradigm for medical image analysis that uses artificial life modelling concepts. Deformable organisms were designed to complement the classical bottom-up deformable models methodologies (geometrical and physical layers), with top-down intelligent deformation control mechanisms (behavioral and cognitive layers). However, a true physical layer was absent and in order to complete medical image segmentation tasks, deformable organisms relied on pure geometry-based shape deformations guided by sensory data, prior structural knowledge, and expert-generated schedules of behaviors. In this paper we introduce the use of physics-based shape deformations within the deformable organisms framework yielding additional robustness by allowing intuitive real-time user guidance and interaction when necessary. We present the results of applying our physics-based deformable organisms, with an underlying dynamic spring-mass mesh model, to segmenting and labelling the corpus callosum in 2D midsagittal magnetic resonance images.

Perioperative Assessment of Myocardial Deformation

PubMed Central

Duncan, Andra E.; Alfirevic, Andrej; Sessler, Daniel I.; Popovic, Zoran B.; Thomas, James D.

2014-01-01

Evaluation of left ventricular performance improves risk assessment and guides anesthetic decisions. However, the most common echocardiographic measure of myocardial function, the left ventricular ejection fraction (LVEF), has important limitations. LVEF is limited by subjective interpretation which reduces accuracy and reproducibility, and LVEF assesses global function without characterizing regional myocardial abnormalities. An alternative objective echocardiographic measure of myocardial function is thus needed. Myocardial deformation analysis, which performs quantitative assessment of global and regional myocardial function, may be useful for perioperative care of surgical patients. Myocardial deformation analysis evaluates left ventricular mechanics by quantifying strain and strain rate. Strain describes percent change in myocardial length in the longitudinal (from base to apex) and circumferential (encircling the short-axis of the ventricle) direction and change in thickness in the radial direction. Segmental strain describes regional myocardial function. Strain is a negative number when the ventricle shortens longitudinally or circumferentially and is positive with radial thickening. Reference values for normal longitudinal strain from a recent meta-analysis using transthoracic echocardiography are (mean ± SD) −19.7 ± 0.4%, while radial and circumferential strain are 47.3 ± 1.9 and −23.3 ± 0.7%, respectively. The speed of myocardial deformation is also important and is characterized by strain rate. Longitudinal systolic strain rate in healthy subjects averages −1.10 ± 0.16 sec−1. Assessment of myocardial deformation requires consideration of both strain (change in deformation), which correlates with LVEF, and strain rate (speed of deformation), which correlates with rate of rise of left ventricular pressure (dP/dt). Myocardial deformation analysis also evaluates ventricular relaxation, twist, and untwist, providing new and noninvasive methods to

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

Bialgebra cohomology, deformations, and quantum groups.

PubMed Central

Gerstenhaber, M; Schack, S D

1990-01-01

We introduce cohomology and deformation theories for a bialgebra A (over a commutative unital ring k) such that the second cohomology group is the space of infinitesimal deformations. Our theory gives a natural identification between the underlying k-modules of the original and the deformed bialgebra. Certain explicit deformation formulas are given for the construction of quantum groups--i.e., Hopf algebras that are neither commutative nor cocommutative (whether or not they arise from quantum Yang-Baxter operators). These formulas yield, in particular, all GLq(n) and SLq(n) as deformations of GL(n) and SL(n). Using a Hodge decomposition of the underlying cochain complex, we compute our cohomology for GL(n). With this, we show that every deformation of GL(n) is equivalent to one in which the comultiplication is unchanged, not merely on elements of degree one but on all elements (settling in the strongest way a decade-old conjecture) and in which the quantum determinant, as an element of the underlying k-module, is identical with the usual one. PMID:11607053

Helium release during shale deformation: Experimental validation

DOE PAGES

Bauer, Stephen J.; Gardner, W. Payton; Heath, Jason E.

2016-07-01

This paper describes initial experimental results of helium tracer release monitoring during deformation of shale. Naturally occurring radiogenic 4He is present in high concentration in most shales. During rock deformation, accumulated helium could be released as fractures are created and new transport pathways are created. We present the results of an experimental study in which confined reservoir shale samples, cored parallel and perpendicular to bedding, which were initially saturated with helium to simulate reservoir conditions, are subjected to triaxial compressive deformation. During the deformation experiment, differential stress, axial, and radial strains are systematically tracked. Release of helium is dynamically measuredmore » using a helium mass spectrometer leak detector. Helium released during deformation is observable at the laboratory scale and the release is tightly coupled to the shale deformation. These first measurements of dynamic helium release from rocks undergoing deformation show that helium provides information on the evolution of microstructure as a function of changes in stress and strain.« less

Deformed Palmprint Matching Based on Stable Regions.

PubMed

Wu, Xiangqian; Zhao, Qiushi

2015-12-01

Palmprint recognition (PR) is an effective technology for personal recognition. A main problem, which deteriorates the performance of PR, is the deformations of palmprint images. This problem becomes more severe on contactless occasions, in which images are acquired without any guiding mechanisms, and hence critically limits the applications of PR. To solve the deformation problems, in this paper, a model for non-linearly deformed palmprint matching is derived by approximating non-linear deformed palmprint images with piecewise-linear deformed stable regions. Based on this model, a novel approach for deformed palmprint matching, named key point-based block growing (KPBG), is proposed. In KPBG, an iterative M-estimator sample consensus algorithm based on scale invariant feature transform features is devised to compute piecewise-linear transformations to approximate the non-linear deformations of palmprints, and then, the stable regions complying with the linear transformations are decided using a block growing algorithm. Palmprint feature extraction and matching are performed over these stable regions to compute matching scores for decision. Experiments on several public palmprint databases show that the proposed models and the KPBG approach can effectively solve the deformation problem in palmprint verification and outperform the state-of-the-art methods.

Phase space deformations in phantom cosmology

NASA Astrophysics Data System (ADS)

López, J. L.; Sabido, M.; Yee-Romero, C.

2018-03-01

We discuss the physical consequences of general phase space deformations on the minisuperspace of phantom cosmology. Based on the principle of physically equivalent descriptions in the deformed theory, we investigate for what values of the deformation parameters the arising descriptions are physically equivalent. We also construct and solve the quantum model and derive the semiclassical dynamics.

Deformation Theory and Physics Model Building

NASA Astrophysics Data System (ADS)

Sternheimer, Daniel

2006-08-01

The mathematical theory of deformations has proved to be a powerful tool in modeling physical reality. We start with a short historical and philosophical review of the context and concentrate this rapid presentation on a few interrelated directions where deformation theory is essential in bringing a new framework - which has then to be developed using adapted tools, some of which come from the deformation aspect. Minkowskian space-time can be deformed into Anti de Sitter, where massless particles become composite (also dynamically): this opens new perspectives in particle physics, at least at the electroweak level, including prediction of new mesons. Nonlinear group representations and covariant field equations, coming from interactions, can be viewed as some deformation of their linear (free) part: recognizing this fact can provide a good framework for treating problems in this area, in particular global solutions. Last but not least, (algebras associated with) classical mechanics (and field theory) on a Poisson phase space can be deformed to (algebras associated with) quantum mechanics (and quantum field theory). That is now a frontier domain in mathematics and theoretical physics called deformation quantization, with multiple ramifications, avatars and connections in both mathematics and physics. These include representation theory, quantum groups (when considering Hopf algebras instead of associative or Lie algebras), noncommutative geometry and manifolds, algebraic geometry, number theory, and of course what is regrouped under the name of M-theory. We shall here look at these from the unifying point of view of deformation theory and refer to a limited number of papers as a starting point for further study.

Deformation of Reservoir Sandstones by Elastic versus Inelastic Deformation Mechanisms

NASA Astrophysics Data System (ADS)

Pijnenburg, R.; Verberne, B. A.; Hangx, S.; Spiers, C. J.

2016-12-01

Hydrocarbon or groundwater production from sandstone reservoirs can result in surface subsidence and induced seismicity. Subsidence results from combined elastic and inelastic compaction of the reservoir due to a change in the effective stress state upon fluid extraction. The magnitude of elastic compaction can be accurately described using poroelasticity theory. However inelastic or time-dependent compaction is poorly constrained. Specifically, the underlying microphysical processes controlling sandstone compaction remain poorly understood. We use sandstones recovered by the field operator (NAM) from the Slochteren gas reservoir (Groningen, NE Netherlands) to study the importance of elastic versus inelastic deformation processes upon simulated pore pressure depletion. We conducted conventional triaxial tests under true in-situ conditions of pressure and temperature. To investigate the effect of applied differential stress (σ1 - σ3 = 0 - 50 MPa) and initial sample porosity (φi = 12 - 24%) on instantaneous and time-dependent inelastic deformation, we imposed multiple stages of axial loading and relaxation. The results show that inelastic strain develops at all stages of loading, and that its magnitude increases with increasing value of differential stress and initial porosity. The stress sensitivity of the axial creep strain rate and microstructural evidence suggest that inelastic compaction is controlled by a combination of intergranular slip and intragranular cracking. Intragranular cracking is shown to be more pervasive with increasing values of initial porosity. The results are consistent with a conceptual microphysical model, involving deformation by poro-elasticity combined with intergranular sliding and grain contact failure. This model aims to predict sandstone deformation behavior for a wide range of stress conditions.

Effect of deformation ratios on grain alignment and magnetic properties of hot pressing/hot deformation Nd-Fe-B magnets

NASA Astrophysics Data System (ADS)

Guo, Zhaohui; Li, Mengyu; Wang, Junming; Jing, Zheng; Yue, Ming; Zhu, Minggang; Li, Wei

2018-05-01

The magnetic properties, microstructure and orientation degrees of hot pressing magnet and hot deformation Nd-Fe-B magnets with different deformation ratios have been investigated in this paper. The remanence (Br) and maximum magnetic energy product ((BH)max) were enhanced gradually with the deformation ratio increasing from 0% to 70%, whereas the coercivity (HCj) decreased. The scanning electron microscopy (SEM) images of fractured surfaces parallel to the pressure direction during hot deformation show that the grains tend to extend perpendicularly to the c-axes of Nd2Fe14B grains under the pressure, and the aspect ratios of the grains increase with the increase of deformation ratio. Besides, the compression stress induces the long axis of grains to rotate and the angle (θ) between c-axis and pressure direction decreases. The X-ray diffraction (XRD) patterns reveal that orientation degree improves with the increase of deformation ratio, agreeing well with the SEM results. The hot deformation magnet with a deformation ratio of 70% has the best Br and (BH)max, and the magnetic properties are as followed: Br=1.40 T, HCj=10.73 kOe, (BH)max=42.30 MGOe.

Anisotropic Ripple Deformation in Phosphorene.

PubMed

Kou, Liangzhi; Ma, Yandong; Smith, Sean C; Chen, Changfeng

2015-05-07

Two-dimensional materials tend to become crumpled according to the Mermin-Wagner theorem, and the resulting ripple deformation may significantly influence electronic properties as observed in graphene and MoS2. Here, we unveil by first-principles calculations a new, highly anisotropic ripple pattern in phosphorene, a monolayer black phosphorus, where compression-induced ripple deformation occurs only along the zigzag direction in the strain range up to 10%, but not the armchair direction. This direction-selective ripple deformation mode in phosphorene stems from its puckered structure with coupled hinge-like bonding configurations and the resulting anisotropic Poisson ratio. We also construct an analytical model using classical elasticity theory for ripple deformation in phosphorene under arbitrary strain. The present results offer new insights into the mechanisms governing the structural and electronic properties of phosphorene crucial to its device applications.

Deformation modes in an Icelandic basalt: From brittle failure to localized deformation bands

NASA Astrophysics Data System (ADS)

Adelinet, M.; Fortin, J.; Schubnel, A.; Guéguen, Y.

2013-04-01

According to the stress state, deformation mode observed in rocks may be very different. Even in the brittle part of the crust a differential stress can induce shear failure but also localized compacting deformation, such as compaction bands in porous sedimentary rocks. The mode of deformation controls many hydrodynamic factors, such as permeability and porosity. We investigate in this paper two different modes of deformation in an Icelandic basalt by using laboratory seismological tools (elastic waves and acoustic emissions) and microstructural observations. First of all, we show that at low effective confining pressure (Peff = 5 MPa) an axial loading induces a shear failure in the basalt with an angle of about 30° with respect to the main stress direction. On the contrary, at high effective confining pressure (Peff ≥ 75 MPa and more) an increase of the axial stress induces a localization of the deformation in the form of subhorizontal bands again with respect to the main stress direction. In this second regime, focal mechanisms of the acoustic emissions reveal an important number of compression events suggesting pore collapse mechanisms. Microstructural observations confirm this assumption. Similar compaction structures are usually obtained for porous sedimentary rocks (20-25%). However, the investigated basalt has an initial total porosity of only about 10% so that compaction structures were not expected. The pore size and the ratio of pore to grain size are likely to be key factors for the particular observed mechanical behavior.

T -folds from Yang-Baxter deformations

NASA Astrophysics Data System (ADS)

Fernández-Melgarejo, José J.; Sakamoto, Jun-ichi; Sakatani, Yuho; Yoshida, Kentaroh

2017-12-01

Yang-Baxter (YB) deformations of type IIB string theory have been well studied from the viewpoint of classical integrability. Most of the works, however, are focused upon the local structure of the deformed geometries and the global structure still remains unclear. In this work, we reveal a non-geometric aspect of YB-deformed backgrounds as T -fold by explicitly showing the associated O( D, D; ℤ) T -duality monodromy. In particular, the appearance of an extra vector field in the generalized supergravity equations (GSE) leads to the non-geometric Q-flux. In addition, we study a particular solution of GSE that is obtained by a non-Abelian T-duality but cannot be expressed as a homogeneous YB deformation, and show that it can also be regarded as a T -fold. This result indicates that solutions of GSE should be non-geometric quite in general beyond the YB deformation.

Accidental degeneracies in nonlinear quantum deformed systems

NASA Astrophysics Data System (ADS)

Aleixo, A. N. F.; Balantekin, A. B.

2011-09-01

We construct a multi-parameter nonlinear deformed algebra for quantum confined systems that includes many other deformed models as particular cases. We demonstrate that such systems exhibit the property of accidental pairwise energy level degeneracies. We also study, as a special case of our multi-parameter deformation formalism, the extension of the Tamm-Dancoff cutoff deformed oscillator and the occurrence of accidental pairwise degeneracy in the energy levels of the deformed system. As an application, we discuss the case of a trigonometric Rosen-Morse potential, which is successfully used in models for quantum confined systems, ranging from electrons in quantum dots to quarks in hadrons.

Instrumentation and fusion for congenital spine deformities.

PubMed

Hedequist, Daniel J

2009-08-01

A retrospective clinical review. To review the use of modern instrumentation of the spine for congenital spinal deformities. Spinal instrumentation has evolved since the advent of the Harrington rod. There is a paucity of literature, which discusses the use of modern spinal instrumentation in congenital spine deformity cases. This review focuses on modern instrumentation techniques for congenital scoliosis and kyphosis. A systematic review was performed of the literature to discuss spinal implant use for congenital deformities. Spinal instrumentation may be safely and effectively used in cases of congenital spinal deformity. Spinal surgeons taking care of children with congenital spine deformities need to be trained in all aspects of modern spinal instrumentation.

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.

Anisotropic ripple deformation in phosphorene

DOE PAGES

Kou, Liangzhi; Ma, Yandong; Smith, Sean C.; ...

2015-04-07

Here, two-dimensional materials tend to become crumpled according to the Mermin-Wagner theorem, and the resulting ripple deformation may significantly influence electronic properties as observed in graphene and MoS 2. Here, we unveil by first-principles calculations a new, highly anisotropic ripple pattern in phosphorene, a monolayer black phosphorus, where compression-induced ripple deformation occurs only along the zigzag direction in the strain range up to 10%, but not the armchair direction. This direction-selective ripple deformation mode in phosphorene stems from its puckered structure with coupled hinge-like bonding configurations and the resulting anisotropic Poisson ratio. We also construct an analytical model using classicalmore » elasticity theory for ripple deformation in phosphorene under arbitrary strain. The present results offer new insights into the mechanisms governing the structural and electronic properties of phosphorene crucial to its device applications.« less

Anisotropic ripple deformation in phosphorene

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kou, Liangzhi; Ma, Yandong; Smith, Sean C.

Here, two-dimensional materials tend to become crumpled according to the Mermin-Wagner theorem, and the resulting ripple deformation may significantly influence electronic properties as observed in graphene and MoS 2. Here, we unveil by first-principles calculations a new, highly anisotropic ripple pattern in phosphorene, a monolayer black phosphorus, where compression-induced ripple deformation occurs only along the zigzag direction in the strain range up to 10%, but not the armchair direction. This direction-selective ripple deformation mode in phosphorene stems from its puckered structure with coupled hinge-like bonding configurations and the resulting anisotropic Poisson ratio. We also construct an analytical model using classicalmore » elasticity theory for ripple deformation in phosphorene under arbitrary strain. The present results offer new insights into the mechanisms governing the structural and electronic properties of phosphorene crucial to its device applications.« less

From labyrinthine aplasia to otocyst deformity.

PubMed

Giesemann, Anja Maria; Goetz, Friedrich; Neuburger, Jürgen; Lenarz, Thomas; Lanfermann, Heinrich

2010-02-01

Inner ear malformations (IEMs) are rare and it is unusual to encounter the rarest of them, namely labyrinthine aplasia (LA) and otocyst deformity. They do, however, provide useful pointers as to the early embryonic development of the ear. LA is characterised as a complete absence of inner ear structures. While some common findings do emerge, a clear definition of the otocyst deformity does not exist. It is often confused with the common cavity first described by Edward Cock. Our purpose was to radiologically characterise LA and otocyst deformity. Retrospective analysis of CT and MRI data from four patients with LA or otocyst deformity. Middle and inner ear findings were categorised by two neuroradiologists. The bony carotid canal was found to be absent in all patients. Posterior located cystic structures were found in association with LA and otocyst deformity. In the most severe cases, only soft tissue was present at the medial border of the middle ear cavity. The individuals with otocyst deformity also had hypoplasia of the petrous apex bone. These cases demonstrate gradual changes in the two most severe IEMs. Clarification of terms was necessary and, based on these findings, we propose defining otocyst deformity as a cystic structure in place of the inner ear, with the cochlea, IAC and carotid canal absent. This condition needs to be differentiated from the common cavity described by Edward Cook. A clear definition of inner ear malformations is essential if outcomes following cochlear implantation are to be compared.

The level of detail required in a deformable phantom to accurately perform quality assurance of deformable image registration

NASA Astrophysics Data System (ADS)

Saenz, Daniel L.; Kim, Hojin; Chen, Josephine; Stathakis, Sotirios; Kirby, Neil

2016-09-01

The primary purpose of the study was to determine how detailed deformable image registration (DIR) phantoms need to adequately simulate human anatomy and accurately assess the quality of DIR algorithms. In particular, how many distinct tissues are required in a phantom to simulate complex human anatomy? Pelvis and head-and-neck patient CT images were used for this study as virtual phantoms. Two data sets from each site were analyzed. The virtual phantoms were warped to create two pairs consisting of undeformed and deformed images. Otsu’s method was employed to create additional segmented image pairs of n distinct soft tissue CT number ranges (fat, muscle, etc). A realistic noise image was added to each image. Deformations were applied in MIM Software (MIM) and Velocity deformable multi-pass (DMP) and compared with the known warping. Images with more simulated tissue levels exhibit more contrast, enabling more accurate results. Deformation error (magnitude of the vector difference between known and predicted deformation) was used as a metric to evaluate how many CT number gray levels are needed for a phantom to serve as a realistic patient proxy. Stabilization of the mean deformation error was reached by three soft tissue levels for Velocity DMP and MIM, though MIM exhibited a persisting difference in accuracy between the discrete images and the unprocessed image pair. A minimum detail of three levels allows a realistic patient proxy for use with Velocity and MIM deformation algorithms.

Deformation Measurements of Smart Aerodynamic Surfaces

NASA Technical Reports Server (NTRS)

Fleming, Gary A.; Burner, Alpheus

2005-01-01

Video Model Deformation (VMD) and Projection Moire Interferometry (PMI) were used to acquire wind tunnel model deformation measurements of the Northrop Grumman-built Smart Wing tested in the NASA Langley Transonic Dynamics Tunnel. The F18-E/F planform Smart Wing was outfitted with embedded shape memory alloys to actuate a seamless trailing edge aileron and flap, and an embedded torque tube to generate wing twist. The VMD system was used to obtain highly accurate deformation measurements at three spanwise locations along the main body of the wing, and at spanwise locations on the flap and aileron. The PMI system was used to obtain full-field wing shape and deformation measurements over the entire wing lower surface. Although less accurate than the VMD system, the PMI system revealed deformations occurring between VMD target rows indistinguishable by VMD. This paper presents the VMD and PMI techniques and discusses their application in the Smart Wing test.

Cardiac fluid dynamics meets deformation imaging.

PubMed

Dal Ferro, Matteo; Stolfo, Davide; De Paris, Valerio; Lesizza, Pierluigi; Korcova, Renata; Collia, Dario; Tonti, Giovanni; Sinagra, Gianfranco; Pedrizzetti, Gianni

2018-02-20

Cardiac function is about creating and sustaining blood in motion. This is achieved through a proper sequence of myocardial deformation whose final goal is that of creating flow. Deformation imaging provided valuable contributions to understanding cardiac mechanics; more recently, several studies evidenced the existence of an intimate relationship between cardiac function and intra-ventricular fluid dynamics. This paper summarizes the recent advances in cardiac flow evaluations, highlighting its relationship with heart wall mechanics assessed through the newest techniques of deformation imaging and finally providing an opinion of the most promising clinical perspectives of this emerging field. It will be shown how fluid dynamics can integrate volumetric and deformation assessments to provide a further level of knowledge of cardiac mechanics.

A Deformable Atlas of the Laboratory Mouse

PubMed Central

Wang, Hongkai; Stout, David B.; Chatziioannou, Arion F.

2015-01-01

Purpose This paper presents a deformable mouse atlas of the laboratory mouse anatomy. This atlas is fully articulated and can be positioned into arbitrary body poses. The atlas can also adapt body weight by changing body length and fat amount. Procedures A training set of 103 micro-CT images was used to construct the atlas. A cage-based deformation method was applied to realize the articulated pose change. The weight-related body deformation was learned from the training set using a linear regression method. A conditional Gaussian model and thin-plate spline mapping were used to deform the internal organs following the changes of pose and weight. Results The atlas was deformed into different body poses and weights, and the deformation results were more realistic compared to the results achieved with other mouse atlases. The organ weights of this atlas matched well with the measurements of real mouse organ weights. This atlas can also be converted into voxelized images with labeled organs, pseudo CT images and tetrahedral mesh for phantom studies. Conclusions With the unique ability of articulated pose and weight changes, the deformable laboratory mouse atlas can become a valuable tool for preclinical image analysis. PMID:25049072

Macroscopic modelling of semisolid deformation for considering segregation bands induced by shear deformation

NASA Astrophysics Data System (ADS)