We present a comparison of preoperative and final postoperative first ray measurements in 109 feet after triplane tarsometatarsal arthrodesis at a mean follow-up time of 17.4 months. Preoperative and final postoperative first ray variables including intermetatarsal angle (IMA), hallux valgus angle (HVA), tibial sesamoid position (TSP), distal metatarsal articular angle (DMAA), Seiberg index, metatarsal rotation angle (MRA), sesamoid subluxation, osseous union, and hardware failure were evaluated. Measurements were made by consistently using the mid-diaphyseal line of the bone segments for both preoperative and postoperative assessments. The mean preoperative HVA, IMA, and TSP were 22.9°, 13.3°, and 4.6. The mean differences (95% confidence interval) in preoperative and postoperative values were -14.9° (-16.3° to -13.4°) for HVA, -7.7° (-8.2° to -7.2°) for IMA, and -2.6 (-2.8 to -2.3) for TSP. Among bunions with MRA measurements, the mean difference was -12.3° (-14.5° to -10.0°). The preoperative to postoperative DMAA decreased by a mean of -14.2° (-15.9° to -12.6°). The results of this study suggest that triplane tarsometatarsal arthrodesis produces appropriate correction of hallux valgus radiographic parameters.

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http://dx.doi.org/10.1053/j.jfas.2019.08.020DOI Listing

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Article Synopsis
  • The study examines the influence of rearfoot position (pronation/supination) and metatarsal torsion on the deformity hallux abducto valgus (HAV) in 12 subjects using weight-bearing CT.
  • Key findings reveal that while first metatarsal eversion is greater in a pronated foot, this difference is not statistically significant; however, there is a strong correlation between metatarsal torsion and eversion, particularly when the foot is pronated.
  • The research highlights the importance of multiple factors, including metatarsal torsion and pronation, in evaluating and treating HAV, suggesting that pre-operative weight-bearing CT scans can aid in surgical planning.
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Lapidus Arthrodesis.

Clin Podiatr Med Surg

April 2022

Orthopedic Foot and Ankle Center, 350 W Wilson Bridge Road Suite 200, Worthington, OH 43085, USA.

There has been significant enhancement in surgical management of hallux valgus deformity. Recognition of the role of medial column hypermobility has resulted in better functional outcomes with decreased risk of recurrence. Modern techniques have evolved to include enhanced fixation in a move toward minimal postoperative downtime.

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Background: The Lapidus procedure using planar saw resection has often been criticized for complications related to excessive shortening and elevation of the first ray. The goal of this study was to assess the amount of shortening that occurs when using a cutting guide for controlled saw resection of the first tarsometatarsal (TMT) joint surfaces, along with assessment of deformity correction in all 3 anatomic planes.

Methods: A prospective multicenter study with IRB approval included 35 hallux valgus subjects evaluated at baseline and 6 months following instrumented triplane first TMT arthrodesis without lesser metatarsal osteotomies.

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We present a comparison of preoperative and final postoperative first ray measurements in 109 feet after triplane tarsometatarsal arthrodesis at a mean follow-up time of 17.4 months. Preoperative and final postoperative first ray variables including intermetatarsal angle (IMA), hallux valgus angle (HVA), tibial sesamoid position (TSP), distal metatarsal articular angle (DMAA), Seiberg index, metatarsal rotation angle (MRA), sesamoid subluxation, osseous union, and hardware failure were evaluated.

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In a hallux valgus deformity, the problem is deviation of the hallux at the metatarsophalangeal joint and of the first metatarsal at the tarsometatarsal joint. Although anterior-posterior radiograph findings have been prioritized, deviation in the other planes can substantially change visible cues. The modified technique for Lapidus procedure procedure, uses all 3 planes to evaluate and correct the deformity, making radiographic measurements less useful.

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