Tibial Sesamoid Position Influence on Functional Outcome and Satisfaction After Hallux Valgus Surgery

Chen, Jerry; Rikhraj, Kiran; Gatot, Cheryl; Lee, Justine Yun Yu; Rikhraj, Inderjeet Singh

doi:10.1177/1071100716658456

Cited by 52 publications

(51 citation statements)

References 25 publications

(31 reference statements)

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“…Previous studies have suggested that reduction of the sesamoids is important for prevention of recurrence and postoperative patient-reported outcomes. 4,24 However, sesamoid position did not correlate with first metatarsal pronation in our study, and there is no literature on the effect of pronation on clinical outcomes in HV. Small differences in angles may have significant consequences on patient-reported outcomes in foot and ankle surgery.…”

Section: Discussioncontrasting

confidence: 75%

Effect of the Modified Lapidus Procedure on Pronation of the First Ray in Hallux Valgus

et al. 2019

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Background: Hallux valgus (HV) is a triplanar deformity of the first ray including pronation of the first metatarsal with subluxation of the sesamoids. The purpose of this study was to investigate if a first tarsometatarsal fusion (modified Lapidus technique), without preoperative knowledge of pronation measured on weightbearing computed tomographic (CT) scans, changed pronation of the first metatarsal and determine if reduction of the sesamoids was correlated with changes in first metatarsal pronation. Methods: Thirty-one feet in 31 patients with HV who underwent a modified Lapidus procedure had preoperative and at least 5-month postoperative weightbearing CT scans and radiographs. Differences in preoperative and postoperative pronation of the first metatarsal using a 3-dimensional computer-aided design, HV angle, and intermetatarsal angle (IMA) were calculated using Wilcoxon signed-rank tests. After dividing patients into groups based on sesamoid station, Kruskal-Wallis H tests were used to compare first metatarsal pronation between the groups. Results: The mean preoperative and postoperative pronation of the first metatarsal was 29.0 degrees (range 15.8-51.1, SD 8.7) and 20.2 degrees (range 10.4-32.6, SD 5.4), respectively, which was a mean change in pronation of the first ray of −8.8 degrees ( P < .001). There was no difference in pronation of the first ray when stratified by postoperative sesamoid position ( P > .250). The average preoperative and postoperative IMA was 16.7 degrees (SD 3.2) and 8.8 degrees (SD 2.8), which demonstrated a significant change ( P < .001). Conclusions: The modified Lapidus procedure was an effective tool to change pronation of the first ray. Reduction of the sesamoids was not associated with postoperative first metatarsal pronation. Level of Evidence: Level IV, case series.

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Section: Discussioncontrasting

confidence: 75%

Effect of the Modified Lapidus Procedure on Pronation of the First Ray in Hallux Valgus

et al. 2019

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“…Postoperatively, two-thirds of the patients in our study had "reduced" sesamoids as defined by Esemenli et al (sesamoid station of grade 1 or less), which is similar to prior studies evaluating sesamoid position following DCO. 3,4,8,17,27,28,33 Though most of the patients in the cohort had adequate sesamoid reduction, nearly half of the patients did not have significant improvement in sesamoid station. Sesamoid position has been shown to be correlated with postoperative functional outcomes and patient satisfaction 4 as well as maintenance of HV correction.…”

Section: Discussionmentioning

confidence: 97%

Distal Chevron Osteotomy Increases Anatomic Intermetatarsal Angle in Hallux Valgus

Chan

Noori

Chen

et al. 2020

Foot & Ankle Orthopaedics

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Background: Distal chevron metatarsal osteotomy (DCO) is a common technique to address hallux valgus (HV), which involves coronal translation of the capital fragment resulting in a nonanatomic first metatarsal. The purpose of this study was to evaluate the radiographic effect of the DCO on the anatomic vs the mechanical axis of the first metatarsal. Our hypothesis was that patients undergoing DCO would have improvement in the mechanical metatarsal axis but worsening of the anatomic axis. Methods: This was a retrospective case series of consecutive patients who underwent DCO for HV. The primary outcomes were the change in anatomic first–second intermetatarsal angle (a1-2IMA) vs mechanical first–second intermetatarsal angle (m1-2IMA). Secondary outcomes included the change in hallux valgus angle (HVA) and medial sesamoid position. Results: 40 feet were analyzed with a mean follow-up of 21.2 weeks. The a1-2IMA increased significantly (mean, 4.1 degrees) whereas the m1-2IMA decreased significantly (mean, 4.6 degrees) following DCO. There was a significant improvement in HVA (mean, 12.5 degrees). Medial sesamoid position was improved in 21 feet (52.5%). Patients with no improvement in sesamoid position were found to have a larger increase in a1-2IMA (mean, 4.7 vs 3.5 degrees, P = .03) and less improvement in m1-2IMA (mean, 3.8 vs 5.2 degrees, P = .02) compared to patients with improvement in sesamoid position. Conclusion: Distal chevron osteotomy for HV was associated with worsening of the anatomic axis of the first metatarsal despite improvements in the mechanical metatarsal axis, HVA, and medial sesamoid position. Greater worsening of the anatomic axis was associated with less improvement of sesamoid position. Our findings may suggest the presence of intermetatarsal instability, which could limit the power of DCO in HV correction for more severe deformities and provide a mechanism for HV recurrence. Level of Evidence: Level IV, retrospective case series.

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“…It has been shown that there is a significant relationship between reduction of TSP and recurrent deformities. 4,20 Okuda et al 20 showed that incomplete sesamoid reduction can lead to recurrent hallux valgus. The current study demonstrated an average TSP improvement of 2.5 positions.…”

Section: Discussionmentioning

confidence: 99%

“…The mean TSP of 2.3 (±1.0) is well within the acceptable postoperative position of 4 or less. 4,20 We understand this measurement is not likely related to the hardware construct, but it is an interesting variable to note. The authors feel the described technique of a small first interspace incision allows for compete release of the lateral sesamoid complex.…”

Section: Discussionmentioning

confidence: 99%

Maintenance of Correction of the Modified Lapidus Procedure With a First Metatarsal to Intermediate Cuneiform Cross-Screw Technique

et al. 2019

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Background: Recurrence of deformity remains a concern when fusing the first tarsometatarsal joint for correction of hallux valgus (HV). A recently described construct adds an additional point of fixation from the plantar medial first metatarsal to the intermediate cuneiform. The purpose of this study was to determine the maintenance of correction of the first and second intermetatarsal angle, hallux valgus angle, and tibial sesamoid position after undergoing a first tarsometatarsal joint arthrodesis using the proposed construct. Methods: A radiographic review was performed of patients with HV treated with a first tarsometatarsal joint arthrodesis with the addition of a cross-screw intermediate cuneiform construct. Three observers reviewed radiographic data, including preoperative weightbearing, first weightbearing, and final weightbearing plain-film radiographs. Initial improvement and maintenance of intermetatarsal angle, hallux valgus angle (HVA), and tibial sesamoid position were evaluated radiographically. A total of 62 patients met inclusion criteria and were included in the study. Mean follow-up time was 9.3 months (SD 6.7). Results: Bony union was achieved in 60 of 62 patients (96.7%). Two of 62 patients required revision surgery as a result of recurrence (3.3%). Final mean improvement of the intermetatarsal angle (IMA) was 6.8 degrees (±2.9 degrees), HVA was 14.8 degrees (±7.5 degrees), and tibial sesamoid position was 2.4 (±1.4) positions. Mean loss of IMA correction was 1.5 degrees (±1.6), HVA was 2.9 degrees (±4.8 degrees), and tibial sesamoid position was 0.8 (±0.8). Conclusion: This study showed that the cross-screw intermediate cuneiform construct for first tarsometatarsal joint arthrodesis had a good union rate, a low complication rate, and maintained radiographic correction. Level of Evidence: Level IV, retrospective case series.

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Tibial Sesamoid Position Influence on Functional Outcome and Satisfaction After Hallux Valgus Surgery

Abstract: Level III, retrospective comparative series.

Cited by 52 publications

References 25 publications

Effect of the Modified Lapidus Procedure on Pronation of the First Ray in Hallux Valgus

Effect of the Modified Lapidus Procedure on Pronation of the First Ray in Hallux Valgus

Distal Chevron Osteotomy Increases Anatomic Intermetatarsal Angle in Hallux Valgus

Maintenance of Correction of the Modified Lapidus Procedure With a First Metatarsal to Intermediate Cuneiform Cross-Screw Technique

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