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Forefoot disorders
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Medial deviation of the lesser toes is more common than lateral deviation. This is commonly associated with hallux valgus. The second toe is most commonly affected (Figure 6.1).
Probabilistic reasoning
Published in Caroline J Rodgers, Richard Harrington, Helping Hands: An Introduction to Diagnostic Strategy and Clinical Reasoning, 2019
Caroline J Rodgers, Richard Harrington
Features seen are: Likely Pseudomonas infection of the right great toenail.Deformity of the toe joints.Very mild bilateral pitting oedema: think about the possible causes for this (e.g. cardiac failure, liver disease, drugs such as calcium channel blockers).Bilateral hallux valgus.Bilateral fungal nail disease of the great toes.Missing toe on the left foot: think about the causes – could it be congenital or an amputation? In this patient, a scar is visible indicating amputation. This could be due to trauma or other causes such as peripheral vascular disease.
Foot and ankle
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Hallux valgus is deviation of the big toe away from the midline, i.e. towards the lesser toes, and is usually associated with a bunion, a swelling made up of both bone and bursa on the medial aspect of the first metatarsal head (Figure 36.2). It is a common condition that affects women more than men, and which is often bilateral. It is believed that the tendency to hallux valgus is inherited and that fully enclosed shoes accelerate the development of the condition.
Disease activity affects the recurrent deformities of the lesser toes after resection arthroplasty for rheumatoid forefoot deformity
Published in Modern Rheumatology, 2021
Taro Kasai, Gen Momoyama, Yuichi Nagase, Tetsuro Yasui, Sakae Tanaka, Takumi Matsumoto
Recurrent hallux valgus deformity is one of the major complications after resection arthroplasty of the hallux, which directly leads to patient dissatisfaction after the procedure [27]. A large preoperative HVA has been well identified as a major risk factor for recurrence after joint-preserving surgery for hallux valgus deformity [29]. Similarly, the preoperative severity of hallux valgus has also been reported to be one of the risk factors of recurrent deformity after resection arthroplasty of the hallucal MTP joints [27]. Although arthrodesis is accompanied by some other specific complications including non-union, irritation by the implanted hardware, interphalangeal joint osteoarthritis, and shoe wear problem or painful callosities caused by inappropriate fixed angle at the MTP joints, arthrodesis is advantageous because it does not cause recurrent hallux valgus deformity after the procedure. Although controversy exists in the choice between resection and arthrodesis for the management of the first metatarsal in resection arthroplasty of the forefoot [30,31], the results of the present study suggest that arthrodesis of the hallux may be considered instead of resection arthroplasty of all 5 metatarsal heads from the aspect of recurrent deformity prevention, especially in cases with severe preoperative HVA regardless of the status of RA disease activity control.
Effectiveness of hallux valgus surgery on patient quality of life: a systematic review and meta-analysis
Published in Acta Orthopaedica, 2020
Luis Enrique Hernández-Castillejo, Vicente Martínez Vizcaíno, Miriam Garrido-Miguel, Iván Cavero-Redondo, Diana P Pozuelo-Carrascosa, Celia Álvarez-Bueno
More than 200 different surgical procedures have been developed for treating hallux valgus (HV) (Myerson 2000, Magnan et al. 2005, Easley and Trnka 2007). Evidence supporting these differing surgical approaches for HV remains inconclusive; therefore, patient-reported outcome measures (PROMs) could be decisive for favoring one approach over another among these numerous surgical alternatives. PROMs are typically classified as pain scales, general scales, and region-specific outcomes. For region-specific PROMs, the Manchester-Oxford Foot Questionnaire (MOXFQ), the Foot and Ankle Outcome Score (FAOS), the Self-reported Foot and Ankle Score (SEFAS) (Schrier et al. 2015), and the American Orthopaedic Foot and Ankle Society (AOFAS) score (Hunt and Hurwit 2013, Arbab et al. 2019, Nilsdotter et al. 2019) have been developed and validated. Generic PROMs, including scales such as the EuroQol-5D (EQ-5D), the Short Form-12 Health Survey (SF-12), and the SF-36, have also been used.
Impact of combining medial capsule interposition with modified scarf osteotomy for hallux valgus
Published in Modern Rheumatology, 2020
Kosuke Ebina, Makoto Hirao, Hideki Tsuboi, Shoichi Kaneshiro, Masataka Nishikawa, Atsushi Goshima, Takaaki Noguchi, Hiroyuki Nakaya, Yuki Etani, Akira Miyama, Kenji Takami, Jun Hashimoto, Hideki Yoshikawa
A recent report demonstrated that the prevalence of radiographic hallux valgus reached 29.8% in an aged cohort (≥65 years) [1], and hallux valgus deformity and the related pain itself impair physical function [2]. The scarf osteotomy is reported as one of the most reliable joint-preserving hallux valgus surgical interventions recommended for the correction of moderate-to-severe hallux valgus deformity [3,4]. However, some patients develop progressive osteoarthritis (joint space narrowing) after scarf osteotomy [3], so alternative treatment options may be required, especially in severe cases. Good clinical outcomes of capsular interposition arthroplasty for hallux rigidus have been reported [5,6]. In addition, the adductor hallucis tendon, which is usually dissected from the hallux proximal phalanx in scarf osteotomy, supports the longitudinal arch (oblique head) and the transverse arch (transverse head). Therefore, we hypothesized that combining medial capsular interposition of the hallux (suturing to the adductor hallucis tendon) with modified scarf osteotomy may improve clinical outcomes, such as pain reduction and maintaining the longitudinal and transverse arches. We have recently reported that this procedure was effective in severe hallux valgus deformity in patients with rheumatoid arthritis [7–9]. The purpose of this study was to clarify the usefulness of combining medial capsular interposition with modified scarf osteotomy for hallux valgus patients (excluding rheumatoid arthritis) by comparing the mid-term clinical outcomes of cases treated with and without medial capsular interposition.