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Background
It is recognized that different types of hallux valgus exist. Classification occurs with radiographic and clinical parameters. Severity of different parameters is used in algorithms to choose between different surgical procedures. Because there is no consensus about each parameter nor their cut-off point we conducted this study to analyze the influence of these variables on the postoperative hallux valgus angle.
Methods
After informed consent 115 patients (136 feet) were included. Bunionectomy, osteotomy, lateralization of the distal fragment, lateral release and medial capsulorraphy were performed in all patients. Data were collected on preoperative and postoperative HVA, IMA and DMAA measurements. Forty cases were included since our findings in a previous article,7 therefore, current data concern an expanded study group with longer follow-up and were not published before. At least two-year follow-up data were evaluated with logistic regression and independent t-tests.
Results
Preoperative HVA was significant for prediction of postoperative HVA in logistic regression. IMA and DMAA were not significant for prediction of postoperative HVA in logistic regression, although they were significantly increased in larger deformities. In patients with preoperative HVA of 37 degrees or more, satisfactory correction could be obtained in 65 percent. The other nine of these 26 patients developed subluxation.
Conclusion
The preoperative HVA was the main radiological predictor for correction of hallux valgus, correction rate declined from preoperative HVA of 37. IMA and DMAA did have a minor role in patients with preoperative HVA lower than 37 degrees, however, likely contributed to preoperative HVA of 37 degrees or more.
Re: Hallux valgus angle as main predictor for correction of hallux valgus
I have to admit I have no idea what this paper is suggesting.
Can someone please explain this.
Thanks
Steve
__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
Re: Hallux valgus angle as main predictor for correction of hallux valgus
Quote:
Originally Posted by drsarbes
I have to admit I have no idea what this paper is suggesting.
Can someone please explain this.
Thanks
Steve
Steve, I don't know much about surgery, but I'm ok with predictive modelling. The paper appears to be suggesting that for the type of surgery performed the preoperative hallux valgus angle (HVA) predicts the post-operative angle obtained at follow-up. That is, a significant proportion of the the variance in post-operative angle was accounted for by the pre-op angle in the population studied. In other words, the pre-op HVA is significant in the post-op HVA obtained. So if we had their model we could measure the pre-op HVA in one of your patients, pump the numbers through the model and know before we performed the type of surgery described what the angle would be in this patient, within statistical limits, two years post-op, without having performed that surgery.Like I said, I'm no surgeon, but I guess this would help you decide whether this specific procedure was the way to go for the patient or not. This assumes that your outcomes would match those of the surgeon in the study- they may, or may not.
While the pre-operative IMA and DMAA do not predict the postoperative HVA- in other words, if you are performing this type of surgery, these angles have little to do with the outcome. So if you are doing this type of surgery they aren't important??????
Re: Hallux valgus angle as main predictor for correction of hallux valgus
Thanks Simon, I appreciate your taking the time to reply.
I guess what I'm confused about is that the osteotomy or procedure performed often depends on the HVA (an angle formed by the first met and the Prox phalanx).
One can put the toe (in relation to the metatarsal) pretty much wherever you'd like to. I try to place it in an anatomic position!
I guess what I still don't understand is why this angle would not be corrected completely by their procedure of choice.
Steve
__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
Re: Hallux valgus angle as main predictor for correction of hallux valgus
Quote:
Originally Posted by drsarbes
I guess what I still don't understand is why this angle would not be corrected completely by their procedure of choice.
Steve
They're not saying that it isn't; what they are saying is the pre-op predicts the post-op, i.e. correlation. Are you sure your immediate post-op position is maintained two years later?
Re: Hallux valgus angle as main predictor for correction of hallux valgus
"Are you sure your immediate post-op position is maintained two years later?"
I like to think so. The only time I normally tell patients that their hallux may migrate over is when they have a very short first metatarsal and or metadductus with the remaining toes also in varus, otherwise, yes, I expect the hallux to look good in two years (or ten for that matter)
OK, I think I understand what they are trying to do. I just find it curious. If this particular procedure is not giving them long standing correction when the HVA is high, then they are not performing the correct procedure! And they performed it anyway to fulfill the study!
Is it me or does this sound , well, "curious"
Steve
__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
Re: Hallux valgus angle as main predictor for correction of hallux valgus
Peter -
The hallux valgus angle is an angle formed between the longitudinal bisection of the proximal phalanx of the hallux and the longitudinal bisection of the first metatarsal. I seem to remember that its less repeatable than the IM angle, probably because forming the longitudinal bisection of the proximal phalanx of the hallux is a bit more variable than on a longer bone (usually with less rotation) such as a metatarsal where it's a bit easier to repeatedly define reference points on your x-ray.
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Hallux valgus angle as main predictor for correction of hallux valgus
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