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Y R Choi - One of the best experts on this subject based on the ideXlab platform.

  • distal chevron Metatarsal Osteotomy is a viable treatment option for hallux valgus with metatarsus adductus multicentre retrospective study
    International Orthopaedics, 2021
    Co-Authors: Jaehyung Lee, Ho Seong Lee, Jaejung Jeong, Dongkyo Seo, Taehong Kee, Y R Choi
    Abstract:

    The purpose of this study was to evaluate the radiographic and clinical outcomes of patients with hallux valgus (HV) with concomitant metatarsus adductus (MA) treated with distal chevron Metatarsal Osteotomy (DCMO), without any procedure for the second or third Metatarsal. A multicentre retrospective study involving four hospitals was conducted. A total of 45 feet from 38 patients who had received DCMO for HV with MA with at least one year post-operative follow-up were analysed. HV angle (HVâ), inter-Metatarsal angle (IMâ), MA angle (MAâ), and the lateral sesamoid grade were measured. Foot function index (FFI) and visual analogue scale (VAS) were recorded. Patients were divided into mild (18° ≤ MAâ   0.05). The total rate of recurrence (HVâ ≥ 20°) was 11.1% (5/45), and although the moderate group (4/29, 13.8%) had a higher proportion than the mild group (1/16, 6.3%), this was not statistically significant (p = 0.641). DCMO for patients with HV with MA had satisfactory radiographic and clinical outcomes with minimal recurrence. Except in cases of severe combined deformity, we recommend performing DCMO alone without any additional procedure or manipulation of the other Metatarsals as a viable treatment option.

  • comparison of open lateral release and transarticular lateral release in distal chevron Metatarsal Osteotomy for hallux valgus correction
    International Orthopaedics, 2013
    Co-Authors: Hannah Chun, Y R Choi
    Abstract:

    Purpose The aim of this study was to investigate the difference in clinical and radiographic outcomes between conventional open lateral soft tissue release (OLSTR) and transarticular lateral soft tissue release (TLSTR) in patients undergoing distal chevron Metatarsal Osteotomy (DCMO) for hallux valgus (HV) correction.

  • distal Metatarsal Osteotomy for hallux varus following surgery for hallux valgus
    Journal of Bone and Joint Surgery-british Volume, 2011
    Co-Authors: K J Choi, Joeun Jeong, Yong-sik Yoon, Soosung Park, Y R Choi
    Abstract:

    We reviewed the outcome of distal chevron Metatarsal Osteotomy without tendon transfer in 19 consecutive patients (19 feet) with a hallux varus deformity following surgery for hallux valgus. All patients underwent distal chevron Metatarsal Osteotomy with medial displacement and a medial closing wedge Osteotomy along with a medial capsular release. The mean hallux valgus angle improved from −11.6° pre-operatively to 4.7° postoperatively, the mean first-second interMetatarsal angle improved from −0.3° to 3.3° and the distal Metatarsal articular angle from 9.5° to 2.3° and the first metatarsophalangeal joints became congruent post-operatively in all 19 feet. The mean relative length ratio of the metatarsus decreased from 1.01 to 0.99 and the mean American Orthopaedic Foot and Ankle Society score improved from 77 to 95 points. In two patients the hallux varus recurred. One was symptom-free but the other remained symptomatic after a repeat distal chevron Osteotomy. There were no other complications. We consider that distal chevron Metatarsal Osteotomy with a medial wedge Osteotomy and medial capsular release is a useful procedure for the correction of hallux varus after surgery for hallux valgus.

Hyungchul Park - One of the best experts on this subject based on the ideXlab platform.

  • a comparison of proximal and distal chevron Osteotomy both with lateral soft tissue release for moderate to severe hallux valgus in patients undergoing simultaneous bilateral correction a prospective randomised controlled trial
    Journal of Bone and Joint Surgery-british Volume, 2015
    Co-Authors: Hyungchul Park, Jongkeun Seon
    Abstract:

    Moderate to severe hallux valgus is conventionally treated by proximal Metatarsal Osteotomy. Several recent studies have shown that the indications for distal Metatarsal Osteotomy with a distal soft-tissue procedure could be extended to include moderate to severe hallux valgus. The purpose of this prospective randomised controlled trial was to compare the outcome of proximal and distal Chevron Osteotomy in patients undergoing simultaneous bilateral correction of moderate to severe hallux valgus. The original study cohort consisted of 50 female patients (100 feet). Of these, four (8 feet) were excluded for lack of adequate follow-up, leaving 46 female patients (92 feet) in the study. The mean age of the patients was 53.8 years (30.1 to 62.1) and the mean duration of follow-up 40.2 months (24.1 to 80.5). After randomisation, patients underwent a proximal Chevron Osteotomy on one foot and a distal Chevron Osteotomy on the other. At follow-up, the American Orthopedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal interphalangeal (MTP-IP) score, patient satisfaction, post-operative complications, hallux valgus angle, first-second interMetatarsal angle, and tibial sesamoid position were similar in each group. Both procedures gave similar good clinical and radiological outcomes. This study suggests that distal Chevron Osteotomy with a distal soft-tissue procedure is as effective and reliable a means of correcting moderate to severe hallux valgus as proximal Chevron Osteotomy with a distal soft-tissue procedure. Cite this article: Bone Joint J 2015;97-B:202–7.

  • comparison of outcomes between proximal and distal chevron Osteotomy both with supplementary lateral soft tissue release for severe hallux valgus deformity a prospective randomised controlled trial
    Journal of Bone and Joint Surgery-british Volume, 2013
    Co-Authors: Hyungchul Park, Jae Yoon Chung
    Abstract:

    Severe hallux valgus deformity is conventionally treated with proximal Metatarsal Osteotomy. Distal Metatarsal Osteotomy with an associated soft-tissue procedure can also be used in moderate to severe deformity. We compared the clinical and radiological outcomes of proximal and distal chevron Osteotomy in severe hallux valgus deformity with a soft-tissue release in both. A total of 110 consecutive female patients (110 feet) were included in a prospective randomised controlled study. A total of 56 patients underwent a proximal procedure and 54 a distal operation. The mean follow-up was 39 months (24 to 54) in the proximal group and 38 months (24 to 52) in the distal group. At follow-up the hallux valgus angle, interMetatarsal angle, distal Metatarsal articular angle, tibial sesamoid position, American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal score, patient satisfaction level, and complications were similar in each group. Both methods showed significant post-operative improvement and high levels of patient satisfaction. Our results suggest that the distal chevron Osteotomy with an associated distal soft-tissue procedure provides a satisfactory method for correcting severe hallux valgus deformity. Cite this article: Bone Joint J 2013;95-B:510–16.

Chris Blundell - One of the best experts on this subject based on the ideXlab platform.

  • outcome of distal metaphyseal Metatarsal Osteotomy dmmo for lesser toe Metatarsalgia in a teaching hospital
    Orthopaedic Proceedings, 2018
    Co-Authors: R Kakwani, S Haque, C Chadwick, Mark B Davies, Chris Blundell
    Abstract:

    Introduction:The surgical treatment of intractable Metatarsalgia has been traditionally been an intra-articular Weil's type of Metatarsal Osteotomy. In such cases, we adopted the option of performing a minimally invasive distal metaphyseal Metatarsal ostetomy (DMMO) to decompress the affected ray. The meta-tarsophalangeal joint was not jeopardised. We present our outcomes of Minimally Invasive Surgery for Metatarsalgia performed at our teaching hospital.Material and methods:This is a multi-surgeon consecutive series of all the thirty patients who underwent DMMO. The sex ratio was M: F- 13:17. Average age of patients was 60 yrs. More than one Metatarsal Osteotomy was done in all cases. The aim was to try and decompress the affected rays but at the same time, restore the Metatarsal parabola.It was performed under image-intensifier guidance, using burrs inserted via stab incisions. Patients were encouraged to walk on operated foot straight after the operation; the rationale being that the Metatarsal length s...

  • outcome of minimally invasive distal Metatarsal metaphyseal Osteotomy dmmo for lesser toe Metatarsalgia
    Foot & Ankle International, 2016
    Co-Authors: S Haque, R Kakwani, C Chadwick, Mark B Davies, Chris Blundell
    Abstract:

    Background:As in all fields of surgery, advances in orthopaedic surgery develop toward less invasive surgical techniques. The advantages of smaller incisions include minimal soft tissue dissection allowing procedures to be performed as outpatient surgery. There is the assumption that this leads to a quicker recovery time permitting an earlier return to work. As with any new surgical technique, there is an associated learning curve. This study looked into the outcome of minimally invasive distal Metatarsal metaphyseal Osteotomy (DMMO) performed at a University Hospital.Methods:Thirty patients underwent minimally invasive surgery for DMMO. There were 13 males and 17 females with an average age of 60 years. More than one Metatarsal Osteotomy was done in all cases to facilitate the moulding of the Metatarsal head to the correct alignment with full weight bearing. The outcome was measured with the Manchester-Oxford Foot Questionnaire (MOXFQ), patient-reported outcome (PRO), and visual analog scale (VAS) pain s...

  • outcome of distal metaphyseal Metatarsal Osteotomy dmmo for lesser toe Metatarsalgia in a teaching hospital
    Journal of Bone and Joint Surgery-british Volume, 2014
    Co-Authors: R Kakwani, S Haque, C Chadwick, Mark B Davies, Chris Blundell
    Abstract:

    Introduction: The surgical treatment of intractable Metatarsalgia has been traditionally been an intra-articular Weil9s type of Metatarsal Osteotomy. In such cases, we adopted the option of performing a minimally invasive distal metaphyseal Metatarsal ostetomy (DMMO) to decompress the affected ray. The meta-tarsophalangeal joint was not jeopardised. We present our outcomes of Minimally Invasive Surgery for Metatarsalgia performed at our teaching hospital. Material and methods: This is a multi-surgeon consecutive series of all the thirty patients who underwent DMMO. The sex ratio was M: F- 13:17. Average age of patients was 60 yrs. More than one Metatarsal Osteotomy was done in all cases. The aim was to try and decompress the affected rays but at the same time, restore the Metatarsal parabola. It was performed under image-intensifier guidance, using burrs inserted via stab incisions. Patients were encouraged to walk on operated foot straight after the operation; the rationale being that the Metatarsal length sets automatically upon weight bearing on the foot. Outcome was measured with Manchester-Oxford Foot Questionnaire9s (MOXFQ9s) and visual analogue pain score (VAS). Minimum follow up was for six months. Results: The average MOXFQ score was 26. Average improvement in the visual analogue pain score was 3.5. VAS deteriorated in three patients9 whose pain got worse after surgery. Among these three, two had a further procedure on their toes. All of the patients experience prolonged forefoot swelling for at least 3 months. Discussion: The most common complication after intra-articular ostetomy of the Metatarsal head is stiffness of the metatarsophalangeal joint. We believe that using minimally invasive surgery with an extra-articular Osteotomy, reduces the soft tissue injury to the joint, and therefore the amount of post-operative stiffness. In our cohort of patients, DMMO is associated with good patient satisfaction and low complication rates in the vast majority of cases.

Mark S Myerson - One of the best experts on this subject based on the ideXlab platform.

  • management of hallux valgus deformity in patients with severe metatarsus adductus a proposed treatment algorithm
    Journal of Bone and Joint Surgery-british Volume, 2016
    Co-Authors: A Aiyer, Mark S Myerson
    Abstract:

    Introduction Metatarsus adductus (MA) increases the risk of recurrence following surgery for hallux valgus (HV). The goal of this study was to analyze patients with severe MA and identify clinical/surgical factors that are associated with a lower rate of recurrent deformity. Methods 587 patients underwent correction of HV deformity. The rate of recurrence of HV was 15% (63 out of 414 patients) in patients without MA (MA angle 31°) were identified; 8 of 19 had associated tarsoMetatarsal arthritis, and two patients had a skew foot deformity. Ten patients had severe valgus lesser toe deformities. Clinical information collected included associated diagnoses, the presence of arthritis of the tarsoMetatarsal joints, the presence and degree of lesser toe valgus deformities and surgical procedures performed. Radiographic recurrence was defined as a postoperative HVA > 20°. Results 9/19 patients were treated with a modified Lapidus procedure and 10 patients underwent a distal first Metatarsal Osteotomy. Of the 9 patients who were treated with a modified Lapidus procedure, 6 patients underwent simultaneous realignment lesser Metatarsal Osteotomy or arthrodesis of the 2 nd /3 rd TMT joints. 1/9 of these patients had radiographic recurrence of deformity. Of the 10 patients who underwent a distal first Metatarsal Osteotomy without realignment proximal Osteotomy or arthrodesis, 5 had recurrence of deformity. Of the 11 patients with severe valgus lesser toe deformity, those who were treated with simultaneous additional distal lesser Metatarsal osteotomies, did not have recurrence of hallux valgus. Conclusion The use of a modified Lapidus procedure led to a lower rate of HV deformity recurrence in comparison to isolated distal first Metatarsal osteotomies. Treatment of lesser toe deformity with distal Osteotomy should be included as part of the treatment algorithm.

  • radiographic results after percutaneous distal Metatarsal Osteotomy for correction of hallux valgus deformity
    Foot & Ankle International, 2007
    Co-Authors: Anish R Kadakia, Jonathan P Smerek, Mark S Myerson
    Abstract:

    Background: The goal of the study was to evaluate the short-term radiographic results and complications of a percutaneous distal Metatarsal Osteotomy for hallux valgus. Methods: From June, 2005, un...

  • result of arthrodesis of the hallux metatarsophalangeal joint using bone graft for restoration of length
    Foot & Ankle International, 2000
    Co-Authors: Mark S Myerson, Lew C Schon, Francis X Mcguigan, Ali Oznur
    Abstract:

    We treated 24 patients (18 women, six men; average age, 46.4 years; (range, 28 to 66 years) with fusion of the hallux metatarsophalangeal (MTP) joint using bone graft for the restoration of the length of the first ray. This procedure was performed after bone loss subsequent to previous surgeries for the correction of hallux valgus and hallux rigidus with: silastic arthroplasty (11), bunionectomy and distal Metatarsal Osteotomy (six), Keller resection arthroplasty (five), and total joint replacement (two). The indication for performing the arthrodesis with bone graft was a short first Metatarsal, and associated Metatarsalgia of the lesser Metatarsals in addition to a painful MTP joint with or without deformity. This bone loss was associated with avascular necrosis of the first Metatarsal (nine patients) and with osteomyelitis (seven patients). Of the 24 patients, 14 underwent additional concurrent surgery for correction of hammer toes (10), excision of a Morton's neuroma (two), and lesser Metatarsal Osteotomy (two). All patients were examined clinically and radiographically at a mean interval of 62.7 months after surgery (range, 26 to 108 months). The patients were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux and MTP 100-point outcome scale. Arthrodesis occurred in 19/24 patients (79.1%) at a mean of 13.3 weeks (range, 11 to 16 weeks), and the first ray was lengthened by a mean of 13 mm (range, 0 to 29 mm). Of the five nonunions, two were asymptomatic, and three were subsequently revised successfully, with arthrodesis occurring at a mean of 10.7 weeks. Complications included one deep infection requiring intravenous antibiotics for treatment of osteomyelitis and two minor superficial wound infections. The mean AOFAS score improved from 39 points (range, 22 to 60 points) to 79 points (range, 64 to 90 points). All patients were satisfied with the final outcome of treatment and stated that they would undergo the surgical procedure again. We concluded that arthrodesis of the hallux MTP joint with bone graft to restore bone loss and length of the first ray may be a worthwhile procedure despite the technical difficulty and the high rate of nonunion.

Makoto Kubota - One of the best experts on this subject based on the ideXlab platform.

  • proximal oblique Metatarsal Osteotomy for hallux valgus using a plantar locking plate
    Foot and Ankle Surgery, 2017
    Co-Authors: Seiya Ohzawa, Makoto Kubota
    Abstract:

    Abstract Background The purpose of this retrospective study was to evaluate the clinical and radiological results of hallux valgus surgery using a plantar locking plate. Methods Proximal oblique Metatarsal Osteotomy combined with distal soft tissue treatment was performed in 59 adult patients (68 feet) with hallux valgus, using an anatomically pre-contoured plantar locking plate for fixation of the Osteotomy. The median age was 64.0 years and the median follow-up period was 16.5 months. Results The mean JSSF scale improved significantly from 56.0 points preoperatively to 95.8 points postoperatively. The mean interMetatarsal angle and hallux valgus angle decreased from 16.4° and 41.8° preoperatively to 4.2° and 10.8° postoperatively, respectively. The mean inclination angle was 19.9° preoperatively and 20.5° postoperatively. Removal of hardware was needed in 2 feet (2.9%). Conclusions Proximal oblique Metatarsal Osteotomy is an effective method for relief of pain and improvement of function in correction of hallux valgus deformity. Use of a plantar locking plate provides sufficient maintenance of the correction, and complications associated with the hardware are rare.

  • Mobility Changes in the First TMT Joint after Proximal First Metatarsal Osteotomy for Hallux Valgus Evaluated by Weightbearing CT and a 3D Analysis System
    SAGE Publishing, 2017
    Co-Authors: Phd ,tadashi Kimura, Makoto Kubota, Hidekazu Hattori, Kazuhiko Minagawa, Naoki Suzuki, Asaki Hattori, Phd ,keishi Marumo
    Abstract:

    Category: Bunion Introduction/Purpose: In a previous study, we found that feet with hallux valgus show significantly greater three-dimensional mobility than normal feet in all joints of the first ray. Displacement was particularly pronounced in the first TMT joints, indicating that this is the primary cause of first ray hypermobility. We developed a plate used specifically for proximal first Metatarsal Osteotomy to perform three-dimensional correction of hallux valgus and associated deformities. In this study, we evaluated changes in mobility of the first TMT joints after surgery in 3D using weightbearing CT. Methods: The subjects were 5 feet of 5 female patients with hallux valgus (mean age 56 years, mean hallux valgus angle 38°). We performed non-weightbearing and weightbearing (using a load equivalent to body weight) CT scans before surgery using an original loading device (Fig a). We reconstructed 3D models from captured images by segmentation and defined axial coordinate system (Fig b). Next, we measured the three-dimensional displacement of the first Metatarsal bone relative to the medial cuneiform bone under weightbearing conditions. At 1 to 1.5 years after proximal Metatarsal Osteotomy for all patients, we performed a follow-up CT scans using the same method and compared preoperative and postoperative displacement. Student’s t- test was performed to statistically compare data and statistical significance was set at p < 0.05. Results: Postoperatively (when performing a follow up CT), the mean hallux valgus angle improved from 38° to 10° and the mean first-second Metatarsal angle improved from 23° to 7°. The mean score on the Japanese Society for Surgery of the Foot hallux scale improved from 62 points to 97 points. Displacement of the first Metatarsal bone relative to the medial cuneiform bone between non-weightbearing and weightbearing conditions decreased significantly in all directions, from 4.2° ± 1.8° to 1.6° ± 1.1° of dorsiflexion (p = 0.02), 4.9° ± 1.8° to 0.7° ± 0.9° of inversion (p = 0.001), and 4.4° ± 1.9° to 1.7° ± 0.8° of adduction (p = 0.01). Conclusion: Displacement of the first TMT joints under weightbearing conditions decreased after our surgery. This indicates that the surgery corrected hallux valgus and associated pes planus and produced favorable functional outcomes by improving the shape of the foot and hypermobility of the first ray through correction of the orientation and tension of surrounding tendons and ligaments and the plantar aponeurosis. In the future, we plan to further examine the pathology and treatment of hallux valgus with a focus on postoperative changes in soft tissue orientation