Understanding Frontal Plane Correction in Hallux Valgus Repair.

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Abstract

[Indexed for MEDLINE] 13. Foot Ankle Int. 2018 Nov;39(11):1272-1277. doi: 10.1177/1071100718783458. Epub 2018 Jun 28. Foot Width Changes Following Hallux Valgus Surgery. Tenenbaum SA(1), Herman A(2), Bruck N(1), Bariteau JT(3), Thein R(1), Coifman O(1). Author information: (1)1 Department of Orthopedic Surgery, Chaim Sheba medical center at Tel Hashomer, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. (2)2 Department of Orthopaedic Surgery, Assuta Ashdod, Ashdod, Israel; affiliated to Bear Sheva university, Bear Sheva, Israel. (3)3 Department of Orthopedics, Emory University School Medicine, Atlanta, GA, USA. BACKGROUND: Hallux valgus (HV) adversely affects quality of life. Patients frequently express concerns regarding postoperative foot appearance, foot width and footwear anticipations. However, only scarce data are available regarding postoperative foot width. MATERIALS AND METHODS: Seventy-one cases with moderate to severe HV treated with scarf osteotomy were included. The average age was 55.7 years (range, 20-76), with average follow-up of 20.7 months (range, 6-96). Patients' medical records were reviewed for demographic, operative, and radiographic data. Foot width was assessed radiographically by measuring both bone (distance between the first and fifth metatarsal heads) and soft tissue width (maximal distance of the soft tissue outline). RESULTS: Preoperative HV deformity (mean hallux valgus angle [HVA] 35.8 degrees, intermetatarsal angle [IMA] 14.1 degrees, and distal metatarsal articular angle [DMAA] 15.2 degrees) was successfully corrected (postoperative mean HVA 13.7 degrees, IMA 6.9 degrees, and DMAA 7.7 degrees). Overall bony foot width was reduced by 5% and soft tissue foot width by 2%. Further analysis showed that 13 feet (18.3%) had increased (>5%) bone width, 26 feet (36.6%) with no change (±5%), and 32 feet (45.1%) for which the width decreased (>5%) postoperatively. Angular deformity (HVA, IMA, and DMAA) showed low correlation with postsurgery foot width. CONCLUSION: HV surgery effect on foot width was very limited, overall reducing foot width by 2%. Furthermore, in only about half of the patients, the postoperative foot width decreased, regardless of angular deformity magnitude. Patients with the widest feet had a decrease in foot width following surgery, whereas patients with the narrowest feet had an increase in foot width. LEVEL OF EVIDENCE: Level III, comparative series. DOI: 10.1177/1071100718783458