Role of Coronal Plane Malalignment in Hallux Valgus Correction

Wagner, Pablo; Wagner, Emilio

doi:10.1016/j.fcl.2019.10.009

Cited by 19 publications

(26 citation statements)

References 27 publications

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“…18 1M pronation has a relevant role in HV physiopathology, as well as in the recurrence of the deformity. 12,22…”

Section: Discussionmentioning

confidence: 99%

“…Clinically, a pronated hallux with nail inclination is the indicative of 1M pronation. 12 On radiographic images, the reference of 1M pronation is the rounded shape of the lateral edge of the 1M head in the anteroposterior (AP) foot weight-bearing radiographic view, as described by Okuda and Yamaguchi (Figure 1). 7,17 In addition, preoperative weight-bearing sesamoid axial view is used to assess sesamoid malposition, or a CT scan.…”

Section: Evaluation Of the First Metatarsal Rotational Deformitymentioning

confidence: 99%

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Management of the Tarsometatarsal Joint in the Rotational Correction of Hallux Valgus by the Modified Lapidus Procedure: Intraoperative Technical Tips to Prevent Complications

Nishikawa

Saito

Mendes

et al. 2021

Foot & Ankle Specialist

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The modified Lapidus procedure is considered a useful tool for correction of multiplanar deformities in the hallux valgus, including first metatarsal pronation. It offers a greater power of correction compared to most other osteotomies. However, postoperative complications can occur in up to 12% of cases. The aim of this study was to describe intraoperative technical tips in the management of the tarsometatarsal joint during multiplanar correction of severe hallux valgus deformity using the modified Lapidus procedure. It is not the authors’ intention to describe a new technique, but to draw attention to intraoperative details in order to prevent complications as nonunion, extension of the first metatarsal and undercorrection of the deformity. Rotational correction of the first metatarsal with adequate bone coaptation of the first metatarsal and the medial cuneiform are the cornerstone for a satisfactory result. Levels of Evidence: Level V, expert opinion

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“…18 1M pronation has a relevant role in HV physiopathology, as well as in the recurrence of the deformity. 12,22…”

Section: Discussionmentioning

confidence: 99%

Section: Evaluation Of the First Metatarsal Rotational Deformitymentioning

confidence: 99%

Management of the Tarsometatarsal Joint in the Rotational Correction of Hallux Valgus by the Modified Lapidus Procedure: Intraoperative Technical Tips to Prevent Complications

Nishikawa

Saito

Mendes

et al. 2021

Foot & Ankle Specialist

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“…A long plantar cut might make the lateral displacement more difficult and, more importantly, can interfere with a safe exit point of the long, proximal screw through the lateral cortex. Recent studies have demonstrated the importance of attention to a correct coronal plane in bunion surgery to achieve sufficient correction and avoid recurrence [ 27 – 29 ]. Biomechanical testing performed by Aiyer et al demonstrated no significant difference in ultimate load, yield load, and stiffness between transverse and Chevron osteotomy constructs for MIS hallux valgus surgery.…”

Section: Surgical Techniquementioning

confidence: 99%

“…According to our experience and other authors [ 31 ], a lateral release is less often necessary than in traditional open Chevron osteotomy, where the distal soft tissue procedure represents an integral part of the surgery and is usually performed at first. If the sesamoids are not covered sufficiently by the metatarsal head (don’t forget to check frontal plane rotation earlier [ 28 , 29 ]), if the great toe still shows a tendency for valgus deviation despite satisfactory osseous correction or if the great toe can not be abducted passively in the MTP1 and feels rather rigid, a distal soft-tissue procedure might be considered and include a lateral capsulotomy and release of the suspension ligament of the lateral sesamoid (Fig. 16 ).…”

Section: Surgical Techniquementioning

confidence: 99%

3rd generation MICA with the “K-wires-first technique” - a step-by-step instruction and preliminary results

Toepfer¹,

Strässle²

2022

BMC Musculoskelet Disord

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Background Minimally-invasive techniques for hallux valgus correction are becoming increasingly popular. In the last decades, multiple techniques for minimally-invasive hallux valgus correction have been described. MICA (Minimally-invasive Chevron & Akin), representing the 3rd generation of minimally-invasive hallux valgus correction, combines the advantages of an extraarticular osteotomy, stable internal fixation, and high potential for correction. This report aims to provide a step-by-step instruction of the surgical technique with the “K-wires-first” MICA modification, illustrated by detailed imaging of both intraoperative fluoroscopy and clinical imaging as well as corresponding sawbone models for each step. Preliminary results including radiological outcome and complications of the first 50 cases will be discussed. Methods Between May 2018 and May 2021, 50 consecutive MICAs in 47 patients were performed with the K-wires-first technique. There were 40 women and 7 men with an average of 57.4y (range 25–78). The mean preoperative IMA was 16.2° (range 11.0–21.5), the HVA 30.6° (range 21.8–42.1). Results There was one intraoperative conversion to an open surgical bunion correction corresponding to a 2% conversion rate respectively (1/50). On 3 feet (2 patients), removal of the Chevron screws was performed after 7, 9, and 12 months due to prominent and disturbing screw heads at the level of the medial cortex, accounting for a revision rate of 6% (3/50). There were no other secondary revision surgeries. The IMA decreased after MICA by a mean of 10.8° from 16.2° to 5.4° and the HVA by a mean of 22.1° from 30.6° to 8.5°, demonstrating MICA’s high potential for correction. Conclusions Compared to other MICA techniques, the K-wires-first modification helps to reduce hardware malpositioning and the risk of conversion to open surgery. Furthermore, our preliminary results demonstrate a high potential for correction even for severe hallux deformities. Trial registration Retrospectively registered, swissethics BASEC-ID 2021–01537, July 16th, 2021 (www.raps.swissethics.ch).

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“…Hallux valgus is a common condition of the foot consisting of a multiplanar deformity that occurs most frequently in women starting in the fourth decade of life. Up to 90% of patients with hallux valgus show deformities in the coronal plane, with metatarsal rotation and, consequently, pronation of the hallux (1) . This deformity plays an important role in disease progression, as it is frequently accompanied by sesamoid subluxation and an imbalance in muscle forces in the first phalangeal-metatarsal joint (2) .…”

Section: Introductionmentioning

confidence: 99%

Radiographic analysis of the effects of first metatarsal rotation in hallux valgus surgery

2021

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Objective: To evaluate whether the initial degree of metatarsal rotation interferes with the surgical correction of severe hallux valgus. Methods: A retrospective study was performed using weight-bearing AP radiographs to measure first metatarsal rotation based on the shape of the lateral edge of the metatarsal head and the hallux valgus (HVA) and intermetatarsal (IMA) angles. Participants were then classified into two groups. Those with less rotational deformity were placed in the negative pronation group, while those with greater rotational deformity were placed in the positive pronation group. Mean HVA and IMA correction were calculated and compared between groups. Participants underwent the modified Lapidus procedure with correction of pronation. Results: Data were collected for 26 feet with hallux valgus. The negative and positive pronation groups contained 14 and 12 feet, respectively. Successful surgical correction of pronation was observed in 11 of the 12 feet, which were ultimately classified in the negative pronation group based on postoperative radiographs. The negative pronation group showed a mean difference of 15.05o in the HVA and 4.20o in the IMA. The positive pronation group showed a mean difference of 14.22o in the HVA and 3.2o in the IMA. These values did not significantly differ between groups. Conclusion: The initial degree of pronation does not affect the degree of angular correction as long as metatarsal rotation is also addressed. Level of Evidence IV; Diagnostic Studies; Case Series.

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Role of Coronal Plane Malalignment in Hallux Valgus Correction

Cited by 19 publications

References 27 publications

Management of the Tarsometatarsal Joint in the Rotational Correction of Hallux Valgus by the Modified Lapidus Procedure: Intraoperative Technical Tips to Prevent Complications

Management of the Tarsometatarsal Joint in the Rotational Correction of Hallux Valgus by the Modified Lapidus Procedure: Intraoperative Technical Tips to Prevent Complications

3rd generation MICA with the “K-wires-first technique” - a step-by-step instruction and preliminary results

Radiographic analysis of the effects of first metatarsal rotation in hallux valgus surgery

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