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Michael J Coughlin - One of the best experts on this subject based on the ideXlab platform.
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Osteochondral Lesions in Surgically Treated Hallux Valgus.
Foot & Ankle International, 2014Co-Authors: James R. Jastifer, Michael J Coughlin, Jesse F. Doty, Faustin R. Stevens, Christopher B. Hirose, Travis J. KempAbstract:Background:Patient dissatisfaction following surgical correction of Hallux Valgus remains a clinical problem. The aim of this study was to investigate articular erosion patterns of the first metatarsal head in patients with Hallux Valgus, to evaluate if the cartilage damage was associated with the degree of Hallux Valgus deformity, and to prospectively evaluate the effect on patient outcomes.Methods:Fifty-six consecutive feet undergoing surgical correction for Hallux Valgus were prospectively enrolled and followed for 24 months postoperatively. In addition to clinical and radiographic examinations, intraoperative measurements were obtained to quantify osteochondral lesion location, size, and grade of the first metatarsal head cartilage.Results:Fifty-one of 56 feet (91%) had osteochondral lesions. The mean number of zones affected was 2.9, and the mean maximum International Cartilage Repair Society (ICRS) scale lesion grade was 2.9 out of 4. A total of 44/56 (79%) completed a minimum of 24 months of follow...
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Hallux Valgus and first ray mobility
Journal of Bone and Joint Surgery American Volume, 2008Co-Authors: Michael J Coughlin, Bertil W SmithAbstract:BACKGROUND: There have been few prospective studies that have documented the outcome of surgical treatment of Hallux Valgus deformities. The purpose of this investigation was to evaluate the effect of operative treatment of Hallux Valgus with use of a proximal crescentic osteotomy and distal soft-tissue repair on the first metatarsophalangeal joint. METHODS: All adult patients in whom moderate or severe subluxated Hallux Valgus deformities had been treated with surgical repair between September 1999 and May 2002 were initially enrolled in the study. Those who had a Hallux Valgus deformity treated with a proximal crescentic osteotomy and distal soft-tissue reconstruction (and optional Akin phalangeal osteotomy) were then invited to return for a follow-up evaluation at a minimum of two years after surgery. Outcomes were assessed by a comparison of preoperative and postoperative pain and American Orthopaedic Foot and Ankle Society scores; objective measurements included ankle range of motion, Harris mat imprints, mobility of the first ray (assessed with use of a validated calibrated device), and radiographic angular measurements. RESULTS: Of the 108 patients (127 feet), five patients (five feet) were unavailable for follow-up, leaving 103 patients (122 feet) with a diagnosis of moderate or severe primary Hallux Valgus who returned for the final evaluation. The mean duration of follow-up after the surgical repair was twenty-seven months. The mean pain score improved from 6.5 points preoperatively to 1.1 points following surgery. The mean American Orthopaedic Foot and Ankle Society score improved from 57 points preoperatively to 91 points postoperatively. One hundred and fourteen feet (93%) were rated as having good or excellent results following surgery. Twenty-three feet demonstrated increased mobility of the first ray prior to surgery, and only two feet did so following the bunion surgery. The mean Hallux Valgus angle diminished from 30° preoperatively to 10° postoperatively, and the mean first-second intermetatarsal angle decreased from 14.5° preoperatively to 5.4° postoperatively. Plantar gapping at the first metatarsocuneiform joint was observed in the preoperative weight-bearing lateral radiographs of twenty-eight (23%) of 122 feet, and it had resolved in one-third (nine) of them after Hallux Valgus correction. Complications included recurrence in six feet. First ray mobility was not associated with plantar gapping. There was a correlation between preoperative mobility of the first ray and the preoperative Hallux Valgus (r = 0.178) and the first-second intermetatarsal angles (r = 0.181). No correlation was detected between restricted ankle dorsiflexion and the magnitude of the preoperative Hallux Valgus deformity, the postoperative Hallux Valgus deformity, or the magnitude of Hallux Valgus correction. CONCLUSIONS: A proximal crescentic osteotomy of the first metatarsal combined with distal soft-tissue realignment should be considered in the surgical management of moderate and severe subluxated Hallux Valgus deformities. First ray mobility was routinely reduced to a normal level without the need for an arthrodesis of the metatarsocuneiform joint. Plantar gapping is not a reliable radiographic indication of hypermobility of the first ray in the sagittal plane. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. ORIGINAL ABSTRACT CITATION:“Hallux Valgus and First Ray Mobility. A Prospective Study” (2007;89:1887-98).
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Hallux Valgus and first ray mobility a prospective study
Journal of Bone and Joint Surgery American Volume, 2007Co-Authors: Michael J Coughlin, Carroll P JonesAbstract:BACKGROUND: There have been few prospective studies that have documented the outcome of surgical treatment of Hallux Valgus deformities. The purpose of this investigation was to evaluate the effect of operative treatment of Hallux Valgus with use of a proximal crescentic osteotomy and distal soft-tissue repair on the first metatarsophalangeal joint. METHODS: All adult patients in whom moderate or severe subluxated Hallux Valgus deformities had been treated with surgical repair between September 1999 and May 2002 were initially enrolled in the study. Those who had a Hallux Valgus deformity treated with a proximal crescentic osteotomy and distal soft-tissue reconstruction (and optional Akin phalangeal osteotomy) were then invited to return for a follow-up evaluation at a minimum of two years after surgery. Outcomes were assessed by a comparison of preoperative and postoperative pain and American Orthopaedic Foot and Ankle Society scores; objective measurements included ankle range of motion, Harris mat imprints, mobility of the first ray (assessed with use of a validated calibrated device), and radiographic angular measurements. RESULTS: Of the 108 patients (127 feet), five patients (five feet) were unavailable for follow-up, leaving 103 patients (122 feet) with a diagnosis of moderate or severe primary Hallux Valgus who returned for the final evaluation. The mean duration of follow-up after the surgical repair was twenty-seven months. The mean pain score improved from 6.5 points preoperatively to 1.1 points following surgery. The mean American Orthopaedic Foot and Ankle Society score improved from 57 points preoperatively to 91 points postoperatively. One hundred and fourteen feet (93%) were rated as having good or excellent results following surgery. Twenty-three feet demonstrated increased mobility of the first ray prior to surgery, and only two feet did so following the bunion surgery. The mean Hallux Valgus angle diminished from 30 degrees preoperatively to 10 degrees postoperatively, and the mean first-second intermetatarsal angle decreased from 14.5 degrees preoperatively to 5.4 degrees postoperatively. Plantar gapping at the first metatarsocuneiform joint was observed in the preoperative weight-bearing lateral radiographs of twenty-eight (23%) of 122 feet, and it had resolved in one-third (nine) of them after Hallux Valgus correction. Complications included recurrence in six feet. First ray mobility was not associated with plantar gapping. There was a correlation between preoperative mobility of the first ray and the preoperative Hallux Valgus (r = 0.178) and the first-second intermetatarsal angles (r = 0.181). No correlation was detected between restricted ankle dorsiflexion and the magnitude of the preoperative Hallux Valgus deformity, the post-operative Hallux Valgus deformity, or the magnitude of Hallux Valgus correction. CONCLUSIONS: A proximal crescentic osteotomy of the first metatarsal combined with distal soft-tissue realignment should be considered in the surgical management of moderate and severe subluxated Hallux Valgus deformities. First ray mobility was routinely reduced to a normal level without the need for an arthrodesis of the metatarsocuneiform joint. Plantar gapping is not a reliable radiographic indication of hypermobility of the first ray in the sagittal plane.
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instructional course lectures the american academy of orthopaedic surgeons Hallux Valgus
Journal of Bone and Joint Surgery American Volume, 1996Co-Authors: Michael J CoughlinAbstract:Hallux Valgus occurs with lateral deviation of the great toe and medial deviation of the first metatarsal. Commonly, the deformity is characterized by progressive subluxation of the first metatarsophalangeal joint (Figs. 1-A, 1-B, and 1-C). Occasionally, there is a static deformity due to Valgus angulation of the distal articular surface of the first metatarsal or the proximal phalangeal articular surface (Fig. 2). Figs. 1-A, 1-B, and 1-C: Radiographs demonstrating the different degrees of a Hallux Valgus deformity. The arrow indicate the direction of the subluxation, and the arrowheads indicate the extent of the joint surface. Fig. 1-A: A mild Hallux Valgus deformity with subluxation of the first metatarsophalangeal joint. The Hallux Valgus angle is 19 degrees, the first-second intermetatarsal angle is 10 degrees, and there is less than 50 per cent (mild) subluxation of the sesamoids. Fig. 1-B: Moderate Hallux Valgus deformity with subluxation of the first metatarsophalangeal joint. The Hallux Valgus angle is 30 degrees, the first-second intermetatarsal angle is 14 degrees, and there is 50 to 75 per cent (moderate) subluxation of the sesamoids. Fig. 1-C: A severe, recurrent Hallux Valgus deformity with severe subluxation of the first metatarsophalangeal joint. The Hallux Valgus angle is 50 degrees, the intermetatarsal angle is 17 degrees, and there is more than 75 per cent (severe) subluxation of the sesamoids. The second metatarsophalangeal joint is dislocated. Radiograph of a foot with moderate Hallux Valgus deformity without subluxation of the first metatarsophalangeal joint. The Hallux Valgus is due mainly to 25 degrees of Valgus angulation of the distal articular surface of the metatarsal. A sagittal groove (or sulcus) has developed medial to the articular surface. There is a prominent medial eminence. The dotted line indicates the medial and lateral extent of the distal articular surface of the metatarsal. Hallux Valgus …
Ozgur Hancerli - One of the best experts on this subject based on the ideXlab platform.
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The effectiveness of distal soft tissue procedures in Hallux Valgus
Journal of Orthopaedics and Traumatology, 2008Co-Authors: Cemil Kayali, Hasan Ozturk, Haluk Agus, Taşkın Altay, Ozgur HancerliAbstract:Background Hallux Valgus is a common disorder affecting mostly women population. Distal soft tissue procedure in the treatment of Hallux Valgus is one of the main operative techniques described. The aim of this study is to evaluate the outcomes of McBride’s distal soft tissue procedure in Hallux Valgus cases. Materials and methods This study includes 30 patients (27 women) having 31 Hallux Valgus, who were treated between 1999 and 2004. Modified McBride’s distal soft tissue procedure was carried out in all cases. Pain status of the cases was recorded by using VAS, clinical assessment described by Bonney and Macnab, and American Orthopaedic Foot and Ankle Society’s (AOFAS) score at the last follow up. Results The mean Hallux Valgus and intermetatarsal angles decreased from 31.4° and 13.8° to 13.5° and 10.5°, respectively, with an average follow-up period of 54.4 months. AOFAS’s score displayed significant improvement from 57 to 87. The mean VAS showed a significant decrease from 8.75 preoperatively to 2.1 at the last follow-up. According to Bonney and Macnab criteria, only one case was accepted as poor result due to 5° Hallux varus. Conclusions McBride’s distal soft tissue procedure yields high rate of satisfaction for mild to moderate Hallux Valgus with no bony complications related to osteotomy.
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The effectiveness of distal soft tissue procedures in Hallux Valgus
Journal of Orthopaedics and Traumatology, 2008Co-Authors: Cemil Kayali, Hasan Ozturk, Haluk Agus, Taşkın Altay, Ozgur HancerliAbstract:Background Hallux Valgus is a common disorder affecting mostly women population. Distal soft tissue procedure in the treatment of Hallux Valgus is one of the main operative techniques described. The aim of this study is to evaluate the outcomes of McBride’s distal soft tissue procedure in Hallux Valgus cases.
Reinhard Schuh - One of the best experts on this subject based on the ideXlab platform.
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plantar pressure characteristics in Hallux Valgus feet
Journal of Orthopaedic Research, 2014Co-Authors: Ulrich Koller, Madeleine Willegger, Reinhard Windhager, Axel Wanivenhaus, Hans-joerg Trnka, Reinhard SchuhAbstract:Due to the pathoanatomical changes in Hallux Valgus feet, the plantar flexion moment of the first metatarsophalangeal joint is reduced. Therefore, load bearing of the Hallux is decreased during push-off. We assessed loading parameters in Hallux Valgus feet. Based on dorsal-plantar weight bearing radiographs of 61 feet, the intermetatarsal-, Hallux Valgus-, distal metatarsal articulation- angle, and sesamoid position were evaluated. Plantar pressure assessment was performed with the emed 1 system during level walking. We found negative correlations between Hallux Valgus angle and peak pressure in the great toe (r ¼� 0.301, p<0.023), the maximum force of the Hallux (r ¼� 0.481, p<0.001), and contact time of the great toe (r ¼� 0.448, p<0.001), and positive correlations for force time integral (r ¼0.348, p<0.001), contact area (r ¼0.307, p<0.020), maximum force (r ¼0.430, p<0.001), and peak pressure (r ¼0.361, p<0.006) of the fifth metatarsal head. A positive correlation between the sesamoid and the metatarsal subluxation regarding maximum force (r ¼0.294, p<0.034), and a negative correlation between the contact area of the Hallux (r ¼� 0.232, p<0.020) was shown. Depending on the severity, Hallux Valgus angle, and sesamoid subluxation, load shows significant lateral transmission in Hallux Valgus feet. 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res Hallux Valgus is a common pathologic, gradually progressive condition of the musculoskeletal system. Due to the weakness of the medial collateral ligament and capsule, the proximal phalanx drifts into Valgus, and the metatarsal head drifts into varus. With increasing deviation of the first metatarsal, the medial sesamoid shifts under the metatarsal head, and the lateral sesamoid shifts into the space between the first and the second metatarsal head. As a consequence, the tendons of the extensor hallucis longus and the flexor hallucis longus are shifted laterally, becoming abduc- tors and thereby exacerbating the deformity. 1,2,3
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Plantar pressure characteristics in Hallux Valgus feet
Journal of Orthopaedic Research, 2014Co-Authors: Ulrich Koller, Madeleine Willegger, Reinhard Windhager, Axel Wanivenhaus, Hans-joerg Trnka, Reinhard SchuhAbstract:Due to the pathoanatomical changes in Hallux Valgus feet, the plantar flexion moment of the first metatarsophalangeal joint is reduced. Therefore, load bearing of the Hallux is decreased during push-off. We assessed loading parameters in Hallux Valgus feet. Based on dorsal-plantar weight bearing radiographs of 61 feet, the intermetatarsal-, Hallux Valgus-, distal metatarsal articulation- angle, and sesamoid position were evaluated. Plantar pressure assessment was performed with the emed 1 system during level walking. We found negative correlations between Hallux Valgus angle and peak pressure in the great toe (r ¼� 0.301, p
Cemil Kayali - One of the best experts on this subject based on the ideXlab platform.
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The effectiveness of distal soft tissue procedures in Hallux Valgus
Journal of Orthopaedics and Traumatology, 2008Co-Authors: Cemil Kayali, Hasan Ozturk, Haluk Agus, Taşkın Altay, Ozgur HancerliAbstract:Background Hallux Valgus is a common disorder affecting mostly women population. Distal soft tissue procedure in the treatment of Hallux Valgus is one of the main operative techniques described. The aim of this study is to evaluate the outcomes of McBride’s distal soft tissue procedure in Hallux Valgus cases. Materials and methods This study includes 30 patients (27 women) having 31 Hallux Valgus, who were treated between 1999 and 2004. Modified McBride’s distal soft tissue procedure was carried out in all cases. Pain status of the cases was recorded by using VAS, clinical assessment described by Bonney and Macnab, and American Orthopaedic Foot and Ankle Society’s (AOFAS) score at the last follow up. Results The mean Hallux Valgus and intermetatarsal angles decreased from 31.4° and 13.8° to 13.5° and 10.5°, respectively, with an average follow-up period of 54.4 months. AOFAS’s score displayed significant improvement from 57 to 87. The mean VAS showed a significant decrease from 8.75 preoperatively to 2.1 at the last follow-up. According to Bonney and Macnab criteria, only one case was accepted as poor result due to 5° Hallux varus. Conclusions McBride’s distal soft tissue procedure yields high rate of satisfaction for mild to moderate Hallux Valgus with no bony complications related to osteotomy.
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The effectiveness of distal soft tissue procedures in Hallux Valgus
Journal of Orthopaedics and Traumatology, 2008Co-Authors: Cemil Kayali, Hasan Ozturk, Haluk Agus, Taşkın Altay, Ozgur HancerliAbstract:Background Hallux Valgus is a common disorder affecting mostly women population. Distal soft tissue procedure in the treatment of Hallux Valgus is one of the main operative techniques described. The aim of this study is to evaluate the outcomes of McBride’s distal soft tissue procedure in Hallux Valgus cases.
Ulrich Koller - One of the best experts on this subject based on the ideXlab platform.
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plantar pressure characteristics in Hallux Valgus feet
Journal of Orthopaedic Research, 2014Co-Authors: Ulrich Koller, Madeleine Willegger, Reinhard Windhager, Axel Wanivenhaus, Hans-joerg Trnka, Reinhard SchuhAbstract:Due to the pathoanatomical changes in Hallux Valgus feet, the plantar flexion moment of the first metatarsophalangeal joint is reduced. Therefore, load bearing of the Hallux is decreased during push-off. We assessed loading parameters in Hallux Valgus feet. Based on dorsal-plantar weight bearing radiographs of 61 feet, the intermetatarsal-, Hallux Valgus-, distal metatarsal articulation- angle, and sesamoid position were evaluated. Plantar pressure assessment was performed with the emed 1 system during level walking. We found negative correlations between Hallux Valgus angle and peak pressure in the great toe (r ¼� 0.301, p<0.023), the maximum force of the Hallux (r ¼� 0.481, p<0.001), and contact time of the great toe (r ¼� 0.448, p<0.001), and positive correlations for force time integral (r ¼0.348, p<0.001), contact area (r ¼0.307, p<0.020), maximum force (r ¼0.430, p<0.001), and peak pressure (r ¼0.361, p<0.006) of the fifth metatarsal head. A positive correlation between the sesamoid and the metatarsal subluxation regarding maximum force (r ¼0.294, p<0.034), and a negative correlation between the contact area of the Hallux (r ¼� 0.232, p<0.020) was shown. Depending on the severity, Hallux Valgus angle, and sesamoid subluxation, load shows significant lateral transmission in Hallux Valgus feet. 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res Hallux Valgus is a common pathologic, gradually progressive condition of the musculoskeletal system. Due to the weakness of the medial collateral ligament and capsule, the proximal phalanx drifts into Valgus, and the metatarsal head drifts into varus. With increasing deviation of the first metatarsal, the medial sesamoid shifts under the metatarsal head, and the lateral sesamoid shifts into the space between the first and the second metatarsal head. As a consequence, the tendons of the extensor hallucis longus and the flexor hallucis longus are shifted laterally, becoming abduc- tors and thereby exacerbating the deformity. 1,2,3
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Plantar pressure characteristics in Hallux Valgus feet
Journal of Orthopaedic Research, 2014Co-Authors: Ulrich Koller, Madeleine Willegger, Reinhard Windhager, Axel Wanivenhaus, Hans-joerg Trnka, Reinhard SchuhAbstract:Due to the pathoanatomical changes in Hallux Valgus feet, the plantar flexion moment of the first metatarsophalangeal joint is reduced. Therefore, load bearing of the Hallux is decreased during push-off. We assessed loading parameters in Hallux Valgus feet. Based on dorsal-plantar weight bearing radiographs of 61 feet, the intermetatarsal-, Hallux Valgus-, distal metatarsal articulation- angle, and sesamoid position were evaluated. Plantar pressure assessment was performed with the emed 1 system during level walking. We found negative correlations between Hallux Valgus angle and peak pressure in the great toe (r ¼� 0.301, p
