SLR - September 2017 - Riley Rampton
Recurrence of Hallux Valgus Can Be Predicted from Immediate Postoperative Nonweightbearing Radiographs
Reference: Park CH, Lee WC. Recurrence of Hallux Valgus Can Be Predicted from Immediate Postoperative Nonweightbearing Radiographs. J Bone Joint Surg Am. 2017 Jul 19; 99 (14): 1190–1197
Scientific Literature Review
Reviewed By: Riley Rampton, DPM
Residency Program: North Colorado Medical Center, Greeley, CO
Podiatric Relevance: One risk of surgical correction of hallux valgus deformity is the recurrence of the deformity. Reported recurrence rates after treatment with a proximal osteotomy range from four percent to 25 percent. If the podiatric surgeon is able to effectively evaluate postsurgical outcomes at the time of surgery, there may be better results. Previous studies have evaluated the intermetatarsal angle, sesamoid position, distal metatarsal angle, metatarsus adductus, shape of metatarsal the head and insufficient correction of the hallux valgus angle. In those studies, only one or two factors have been analyzed. Therefore, it would be beneficial to have a comprehensive study to evaluate all factors that may lead to recurrence of hallux valgus. The goal of this study is to identify specific risk factors for recurrence and to clarify whether recurrence after surgery can be predicted using radiographic parameters assessed on immediate postoperative nonweightbearing radiographs. If intraoperative radiographs indicate a risk for recurrence, changes in the procedure can be made to appropriately correct the deformity.
Methods: A proximal chevron osteotomy combined with a distal soft-tissue procedure was performed by a single surgeon to treat moderate to severe hallux valgus deformity in 93 patients (117 feet). The feet were grouped according to nonrecurrence or recurrence. Changes in the hallux valgus angle, the intermetatarsal angle and sesamoid position over time were analyzed by comparing values measured during each postoperative period. The relative risks of recurrence as indicated by preoperative and postoperative radiographic parameters were determined.
Results: Twenty (17.1 percent) of the 117 feet showed hallux valgus recurrence. An immediate postoperative hallux valgus angle greater than eight, an immediate postoperative sesamoid position of grade 4 or higher, a preoperative metatarsus adductus angle greater than 23 and preoperative hallux valgus angle greater than 40 were all associated with an increase in recurrence of the deformity.
Conclusions: The authors concluded that the recurrence of hallux valgus can reliably be predicted from immediate postoperative nonweightbearing radiographs. They came to this conclusion by evaluating radiographs that were taken nonweightbearing immediately postoperative and also six months postoperative. The data reviewed also indicates that an alternate procedure should be considered for patients who present with a high metatarsus adductus angle and hallux valgus angle. It is also important that strict protocols be followed for postoperative radiographs to ensure that the radiographs can be accurately evaluated. Overall, this technique will assist the surgeon in proper procedure selection for patients with hallux valgus deformity.