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Valgus Deformity of the Hindfoot
Published in Benjamin Joseph, Selvadurai Nayagam, Randall T Loder, Anjali Benjamin Daniel, Essential Paediatric Orthopaedic Decision Making, 2022
Plain radiographs of the foot and ankle were difficult to interpret on account of the severe valgus deformity (Figure 7.3). The ankle mortise was not grossly tilted in valgus, the distal tibial epiphysis was not wedge-shaped, and the lateral malleolus was not situated proximally. The absence of these features indicated that the deformity was not at the ankle. Since the subtalar joint could not be visualised clearly on the plain radiographs, CT scans were done. The CT scan clearly showed that the ankle joint was almost horizontal but the subtalar joint was abnormally inclined at about 65 degrees from the horizontal. On account of this, the calcaneum was not under the tibia but was laterally displaced (Figure 7.4a, b).
Foot and ankle disorders
Published in Maneesh Bhatia, Tim Jennings, An Orthopaedics Guide for Today's GP, 2017
As this is a progressive condition, it has been classified into four stages: Stage I: Acute stage of medial pain and swelling. This is due to tenosynovitis and the tendon is intact. There is no deformity, and the patient can perform a single heel raise.Stage II: Tendon is torn and is weak. The deformity is correctible. On bilateral heel raise, the valgus deformity corrects. The patient cannot perform a single heel raise.Stage III: There is a fixed valgus deformity, which does not correct on bilateral heel raise test. The patient cannot perform a single heel raise.Stage IV: In addition to the above, this is associated with radiographic changes of arthritis.
Fibular hemimelia
Published in Benjamin Joseph, Selvadurai Nayagam, Randall Loder, Ian Torode, Paediatric Orthopaedics, 2016
At the knee a valgus deformity is usually present and this arises from a deficiency in development of the lateral femoral condyle. It is important to address this deformity irrespective of whether the foot is retained or ablated. In both groups the mechanical loads on the knee are inappropriate and may also lead to patellar subluxation or dislocation even if a patellar tendon supracondylar prosthesis is employed. If the valgus is left untreated in children using a prosthesis following ablation of the foot, it can make alignment of the prosthetic limb difficult. The prosthetist will need to shift the distal component of the prosthesis medially to get the foot close to the mechanical axis of the limb. This will be increasingly difficult as the child grows and the prosthesis will have an unsightly bump on its lateral aspect.
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.
Appearance of hindfoot valgus deformity and recurrence of hallux valgus in the very early period after hallux valgus surgery in a poorly controlled rheumatoid arthritis case: A case report
Published in Modern Rheumatology, 2019
Makoto Hirao, Kosuke Ebina, Hideki Tsuboi, Takaaki Noguchi, Jun Hashimoto, Hideki Yoshikawa
In progress of medical treatment to control the disease activity of rheumatoid arthritis (RA) using methotrexate (MTX) and/or biologics, several joint preserving surgeries has been established for RA forefoot deformity and disability [1–5]. However, there are many opportunities to see comprehensive joint destructions and deformities in RA feet. Recently, it has come to be known that there are certain associations between forefoot and hindfoot deformities [6]. Hallux valgus (HV) deformity is known to be associated with hindfoot valgus deformity. Valgus hindfoot causes abnormal and excessive forefoot pressure on the medial side [7], and any foot with flatfoot and HV has a risk of more rapid progression because of the forces that exacerbate further deformity [8]. Thus, it is plausible that if valgus hindfoot remains and/or appears after HV surgery, the affected foot is at risk for recurrence of HV deformity. A case suggesting the possibility that hindfoot valgus deformity appeared after HV surgery because of poor control of RA disease activity, subsequently the HV deformity recurred in the very early period after surgery, is presented.
Limb lengthening and deformity correction with externally controlled motorized intramedullary nails: evaluation of 50 consecutive lengthenings
Published in Acta Orthopaedica, 2019
Joachim Horn, Ivan Hvid, Stefan Huhnstock, Anne B Breen, Harald Steen
The patients’ mean age at operation was 23 years (11–61). The leg length discrepancy (LLD) was caused by various etiologies (Table 1). In 3 patients consecutive lengthening of both femora was performed due to short stature below 2 SD from average adult height (diagnoses: Léri–Weill dyschondrosteosis, achondroplasia, neonatal growth restraint due to prematurity). Initial deformities included shortening in all patients with a mean of 41 mm (25–88). 23 patients received retrograde femoral nails (RFN), 21 antegrade femoral nails (AFN), and 6 tibia nails (TN). None of the patients had been previously lengthened in the respective segment. In 15 procedures, simultaneous axial correction was done using the RFN. 8 of these patients had initial valgus deformity with a mean lateral (positive) mechanical axis deviation (MAD) of 21 mm (4–50), 5 patients had a varus deformity with a mean medial (negative) MAD of –31 mm (–14 to –58) and 2 patients had a femoral procurvatum deformity of 12° and 26°, respectively. In the remaining 35 procedures, isolated lengthening was performed (21 AFN, 8 RFN, and 6 TN). Mean follow-up after consolidation of the regenerate was 28 months (12–72).