Preliminary Experience With a Minimally Invasive Technique for Hallux Valgus Correction With No Fixation

Abstract

Background: Percutaneous operative techniques for hallux valgus (HV) correction are less damaging to soft tissues and the first metatarsophalangeal joint, and they carry a lower risk of wound complications. We report our preliminary results using a percutaneous technique that allowed correction of the deformity without internal fixation. Methods: One hundred ninety-five consecutive patients with isolated symptomatic HV were surgically treated using a percutaneous technique without any form of internal fixation, with a mean follow-up of 34.6 months. The American Orthopaedic Foot & Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale score was used for clinical assessment. Radiographic evaluation included pre- and postoperative assessment of the hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), and sesamoid position in weightbearing radiographs. Results: According to the AOFAS score, the patients improved from a preoperative median of 54.7 to 89.6 at 2 years’ follow-up ( P = .002). Patients were satisfied or very satisfied in 94% of cases at the latest follow-up. A mean radiographic correction of the HVA of 15.5 degrees, of the IMA of 5.4 degrees, and of the DMAA of 5.4 degrees was achieved. The AOFAS global score and every individual parameter improved significantly between pretreatment and latest follow-up ( P > .01). A total of 19 (9.7%) complications were reported. Conclusion: This percutaneous technique, which did not use any form of internal fixation described, produced durable results for the correction of HV, reliably correcting the deformity and resulting in significant improvement in function and decrease of pain. Level of Evidence: Level IV, retrospective case series.

Pre- and Post-Operative Relationship between Radiological Measures and Clinical Outcomes in Women with Hallux Valgus

“…The first point to be highlighted in this work is the fact that the HVA and IMA values, the variables most frequently used to quantify HV deformities, significantly improved from before the operation to the follow-up. This has also been frequently reported with the use of different surgical techniques [3,7,15,19,22,[29][30][31]. In our work, two of the parameters used to assess the sesamoid position, namely, the DFS and TMH, also significatively improved from the pre-to the postoperative assessment.…”

Finite Element Analysis of Generalized Ligament Laxity on the Deterioration of Hallux Valgus Deformity (Bunion)

“…Besides, Brilakis et al (2019) compared the procedure variation of Mitchell's procedure with and without pins and quantified the additional stability contributed by the use of pins. However, none of these simulations could address the high recurrence in surgical treatment (Lucattelli et al, 2020) and we hoped that our study regarding the relationship between intrinsic cause and deterioration factors could provide more insights to tackle this issue.…”

Normative Distribution of First Metatarsal Axial Rotation

“…Subsequently, reliable and reproducible 2D measures of HV severity such as the hallux valgus angle and intermetatarsal angle were developed and are still used ubiquitously today. 2,16,17,21,27,36,46 Further, numerous operations to normalize these quantitative measures of HV deformity also exist. 9,16,46 Despite the use of these 2D quantitative measures and operative correction of sagittal and transverse plane deformities, consistent rates of poor outcomes and HV recurrence persist with operative correction.…”