COMPARATIVE RADIOGRAPHIC ANALYSIS OF THE RESULTS OF TREATMENT OF HALLUX VALGUS DEFORMITY ACCORDING TO MITCHELL AND KELLER OPERATIVE METHODS

Daniela Georgieva, Anastasika Poposka, Zoran Bozinovski, Milan Samardziski, Roza Dzoleva Tolevska, Jasminka Nanceva

Abstract


Abstract

Introduction: Hallux valgus represents a complex progressive deformity of the front part of the foot, with the most distinguished malformation as lateral deviation of the toe. Radiography is extremely important in the decision of the surgical procedure for the best correction of this deformity. Aim:The aim of this work is to show the significance of radiographic examinations in operated patients with Hallux Valgus deformityaccording to Mitchell and Keller techniques. Material and methods: The study included 70 patients having hallux valgus deformity of the foot, and they were divided to two groups. The patients were grouped according their sex, age, the degree of deformity (moderate or severe degree of deformity) and according to radiographic findings. The first group (Group 1) was composed of 35 patients who were treated by osteotomy of the 1st metatarsal bone according to Mitchell, while the second group (Group 2) was also composed of 35 patients who were treated by resectional arthroplasty according to Keller. Radiographic examinations (Method of Hardy and Clapham, Piggott classification, presence and absence of the secondary arthritic and reactive changes of the first metatarsophalangeal joint) were analyzed comparatively during the evaluation. The analyses of the radiographic results were performed pre-operatively and post-operatively for the two groups.

Results: According to their sex, the patients were 5 men and 65 women. The average age of the patients in group 1 was 42 years, while for group 2 it was 56 years. There is no significant difference (p>0.05) in the patients of the two groups concerning the pre-operative mean dimension values of the I metatarsophalangeal angle and 1st intermetatarsal angle. However, the radiographic analysis of the same angles in both groups, one year post-operatively, showed a high statistically significant difference (p<0.001). The patients operated by Mitchell’s technique, according to Piggott classification, have deviation significantly more often on the 1st metatarsophalangeal joint of 51.43% as a result of their hallux valgus deformity. Significantly more often, there is a subluxation of 77.14% on the 1st metatarsophalangeal joint in the patients treated by Keller’s technique. The radiographic analysis of the 1st metatarsophalangeal joint (presence and absence of the secondary arthritic and reactive changes) in both groups, pre-operatively (p<0.01) and one year post-operatively (p<0.001), showed a high statistically significant difference.

Conclusion: Radiographic analyses were of enormous benefit as in the choice of the decision on the type of the operative procedure and also for the evaluation of the postoperative results.

Key words: radiographic analysis, Mitchell, Keller, hallux valgus



Keywords


Radiographic analysis, Michell, Keller, Hallux Valgus

Full Text:

PDF

References


Perera AM, Mason L, Stephens MM. The Pathogenesis of hallux valgus. J Bone Joint Surg Am. 2011; 93(17):1650-61.

Nix SE, Vicenzino BT, Collins NJ, Smith MD. Characteristics of foot structure and footwear associated with hallux valgus: a systematic review. Osteoarthritis Cartilage. 2012; 20(10):1059-74.

Nery C, Coughlin MJ, Baumfeld D, Ballerini FJ, Kobata S. Hallux valgus in males--part 2: radiographic assessment of surgical treatment. Foot Ankle Int. 2013; 34(5):636-44.

Nery C, Coughlin MJ, Baumfeld D, Ballerini FJ, Kobata S.Hallux valgus in males-part 1: demographics, etiology, and comparative radiology. Foot Ankle Int. 2013; 34(5):629-35.

Aster AS, Forster MC, Rajan RA, Patel KJ, Asirvatham R, Gillies C. Radiographic pre-operative assessment in hallux valgus: is it reliable? The Foot. 2004; 14(3):129-32.

Berquist TH. Radiology of the Foot and Ankle. 2nd ed. Philadelphia;London:Lippincott Williams & Wilkins, 2000.

Iselin LD, Munt J, Symeonidis PD, Klammer G, Chehade M, Stavrou P. Operative management of common forefoot deformities: a representative survey of Australian orthopaedic surgeons. Foot Ankle Spec. 2012; 5(3):188-94.

Joseph TN, Mroczek KJ. Decision making in the treatment of hallux valgus. Bull NYU Hosp Jt Dis. 2007;65(1):19-23.

Kitson K. Bunions: their origin and treatment. J Perioper Pract. 2007; 17(7):308-15.

Chong A, Nazarian N, Chandrananth J, Tacey M, Shepherd D,Tran P. Surgery for the correction of hallux valgus: Minimum five-year results with a validated patient-reported outcome tool and regression analysis. Bone Joint J.2015;97-B(2):208-14.

Spruce MC, Bowling FL, Metcalfe SA. A longitudinal study of hallux valgus surgical outcomes using a validated patient centred outcome measure. Foot (Edinb). 2011;21(3):133-7.

Srivastava S, Chockalingam N, Fakhri T. Radiographic measurements of hallux angles: a review of current techniques. The Foot. 2010; 20(1):27-31.

Kalender AM, Uslu M, Bakan B, et al. Mitchell's osteotomy with mini-plate and screw fixation for hallux valgus.Foot Ankle Int. 2013; 34(2):238-43.

Srivastava S, Chockalingam N, El Fakhri T. Radiographic angles in hallux valgus: comparison between manual and computer-assisted measurements. J Foot Ankle Surg. 2010; 49(6):523-8.

Ferrari J. Bunions. BMJ ClinEvid. 2009.

Panchbhavi VK, Rapley J, Trevino SG. First web space soft tissue release in bunion surgery: functional outcomes of a new technique. Foot Ankle Int. 2011; 32(3):257-61.

Easley ME, Trnka HJ.Current concepts review: hallux valgus part II: operative treatment. Foot Ankle Int.2007; 28(6):748-58.

Gadek A, Walczak J, Wiecek R, Grzenia G.Kramer's and Keller's methods in hallux valgus deformation treatment. Przegl Lek. 2007;64(1):15-8.




DOI: http://dx.doi.org/10.24125/sanamed.v11i1.82

Refbacks

  • There are currently no refbacks.


Copyright (c) 2016 SANAMED

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.