Hallux Valgus

PurposeThe purpose of this study was to compare a minimally invasive chevron osteotomy technique (MIS group) and the well-established open chevron technique (OC group) for correction of hallux valgus deformity.MethodsPatients who were scheduled to undergo a hallux valgus surgery by means of a distal chevron osteotomy were randomly assigned to one of the two groups. Pre-operatively, six weeks, 12 weeks, and nine months post-operatively the following outcome parameters were determined: Visual Analog Scores (VAS) of pain, the American Orthopedic Foot and Ankle Society (AOFAS) forefoot score, radiographic outcome measures, range of motion (ROM), and patient satisfaction.ResultsForty-seven cases were analyzed (25 MIS group; 22 OC group). Both operative techniques achieved significant correction of the hallux deformity. The intermetatarsal angle (IMA) improved from 15.1° to 5.8° in the OC and from 14° to 6.8°in the MIS group, whereas the hallux valgus angle (HVA) improved from 28.3° to 8.5° in the OC versus 26.4° to 6.9° in the MIS group. No significant differences were observed between the groups by any of the determined outcome parameters. Regarding patient satisfaction, statistically significant differences were found between MIS and open surgery 12 weeks post-operatively in favour of the MIS group (p = 0.022).ConclusionWith the minimally invasive chevron osteotomy, radiological and clinical outcome is comparable to the open technique.

BackgroundThough hallux valgus is a common foot deformity, the integrated information on its global prevalence and incidence is relatively lacking. The aim of this research was to assess the global prevalence and incidence of hallux valgus, thus providing reliable data reference for clinical practice.MethodsA systematic review of global hallux valgus research publications concerning its prevalence and incidence was performed based on six electronic databases ((PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), China Online Journals and CQVIP)) from their inception to November 16, 2022. The search terms included "hallux valgus or bunion and prevalence or incidence or epidemiology." All languages were included. Data were extracted by country, continent, age group, gender and other information. The risk of bias was assessed by the Joanna Briggs Institute Critical Appraisal Instrument for Studies Reporting Prevalence Data by using random-effects models to synthesize available evidence.ResultsA total of 45 studies were included in the meta-analysis. The overall pooled estimated prevalence was 19% (95% CI, 13% to 25%) (n=186,262,669) for hallux valgus. In subgroup meta-analyses, the prevalence of hallux valgus was 21.96% (95% CI, 10.95% to 35.46%) in Asia, 3% (95% CI, 0% to 15%) in Africa, 18.35% (95% CI, 11.65% to 26.16%) in Europe, 29.26% (95% CI, 4.8% to 63.26%) in Oceania, and 16.1% (95% CI, 5.9% to 30.05%) in North America, respectively. The pooled prevalence of hallux valgus by gender was 23.74% (95% CI, 16.21% to 32.21%) for females and 11.43% (95% CI, 6.18% to 18%) for males. The prevalence was 11% (95% CI, 2% to 26%) in individuals younger than 20 years old, 12.22% in adults aged 20-60 years (95% CI, 5.86% to 20.46%) and 22.7% in elderly people aged over 60 years (95% CI, 13.1% to 33.98%).ConclusionThis research provided the global prevalence and incidence of hallux valgus in terms of its spatial, temporal, and population distribution. The global estimated pooled prevalence and incidence of hallux valgus was 19%. A higher prevalence of hallux valgus was found in females, Oceania countries, and among people aged over 60 years. Due to the high heterogeneity of the included studies, the findings should be interpreted with caution.

Hallux valgus deformity is a multiplanar deformity, where the rotational component has been recognized over the past 5 to 10 years and given considerable importance. Years ago, a rounded shape of the lateral edge of the first metatarsal head was identified as an important factor to detect after surgery because a less rounded metatarsal head was associated to less recurrence. More recently, pronation of the metatarsal bone was identified as the cause for the rounded appearance of the metatarsal head, and therefore, supination stress was found to be useful to achieve a better correction of the deformity. Using CT scans, up to 87% of hallux valgus cases have been shown to present with a pronated metatarsal bone, which highlights the multiplanar nature of the deformity. This pronation explained the perceived shape of the metatarsal bone and the malposition of the medial sesamoid bone in radiological studies, which has been associated as one of the most important factors for recurrence after treatment. Treatment options are discussed briefly, including metatarsal osteotomies and tarsometatarsal arthrodesis.

IntroductionHallux valgus (HV) is a prevalent forefoot deformity that alters foot shape and occurs more frequently in women and older adults. Few studies have investigated the influence of HV on three-dimensional (3D) foot structure in age-matched samples.MethodsThis cross-sectional study utilised data from two separate studies conducted in Melbourne, Australia. Twenty women (mean ± SD age = 63.8 ± 8.7 years) with HV were age-matched to 20 women without HV (63.8 ± 8.6 years). Participants underwent 3D foot scanning, comparing measurements of the most symptomatic HV feet with corresponding control feet. Differences in foot dimensions between groups were calculated using independent sample t-tests.ResultsWomen with HV demonstrated larger foot breadth (103.1 ± 6.2 vs. 98.0 ± 5.6, mean difference [MD] = 5.13 mm, p = 0.009), ball girth circumference (245.9 ± 13.9 vs. 234.1 ± 11.5, MD = 11.86 mm, p = 0.006), heel breadth (65.9 ± 3.9 vs. 62.8 ± 3.8, MD = 3.13 mm, p = 0.015), height of top of ball girth (39.9 ± 2.8 vs. 37.4 ± 2.2, MD = 2.56 mm, p = 0.003), and toe 1 angle (24.1 ± 8.0 vs. 9.8 ± 8.0, MD = 14.29°, p ConclusionWomen with HV exhibited a broader forefoot and heel compared with those without the deformity. Moreover, women with HV displayed a larger ball girth circumference and height of the top of the ball girth, suggesting that vertical dimensional changes occur in this condition. These findings suggest that individuals with HV may benefit from adequate footwear fitting and new lacing techniques and inform the development of targeted footwear modifications or HV-specific footwear manufacturing guidelines.