SLR - January 2010 - Simon McCoy
Reference:
Okuda, R., Kinoshita, M., Yasuda, T., Jotoku, T., Kitano, N., et al. (2009). Postoperative incomplete reduction of the sesamoids as a risk factor for recurrence of hallux valgus. Journal of Bone & Joint Surgery (American), 91(7), 1637-1645.
Scientific Literature Review
Reviewed by: Simon McCoy
Residency Program: Botsford Hospital
Podiatric Relevance:
Postoperative reduction of the sesamoids is an important component to hallux abductovalgus (HAV) corrective surgery. Failure to address the sesamoid position during surgical correction may render even the best anatomic correction of the hallux as incomplete and at risk for redevelopment of HAV deformity.
Methods:
Anterior/Posterior views of 65 women with HAV deformity and 60 women with normal feet were reviewed. The 65 women with the HAV deformities were treated operatively with a proximal 1st metatarsal osteotomy and followed from one to six months post-operatively. The tibial sesamoid position was graded based on the Hardy and Clapham classification with normal position being defined as less than or equal to 4. These women then were followed and evaluated for recurrence of the HAV deformity and compared to the normal foot group
Results:
All 65 of the feet in the HAV presurgical group were graded with a tibial sesamoid position of greater than or equal to five. Postoperatively at early followup, 48 (74%) feet were classified as grade four or less. At a later followup visit, only 65% were classified as a grade four or less. Similarly, at the preoperative evaluation, the average HAV angle was 38.3 degrees. At early post operative evaluation the average HAV angle was 11.9. At a later post operative visit the average angle was 13.9 degrees. In the control group, there was no significant change in the HAV angle.
Conclusion:
Incomplete reduction of the sesamoids or the failure to address the sesamoid position intraoperatively can lead to the recurrence of hallux valgus deformity. Modifying surgical procedures to address the sesamoid positionmay improve long term HAV surgical prognosis and decrease the recurrence of HAV deformity in the surgical patient.