We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Effect of the Reversed L-Shaped Osteotomy on the Round Sign: Not All Hallux Valgus Deformities May Need Proximal Derotation to Correct the Radiographic Appearance of Metatarsal Pronation.
- Authors
Weigelt, Lizzy; Wild, Linda; Winkler, Elin; Torrez, Carlos; Jentzsch, Thorsten; Wirth, Stephan H.
- Abstract
Background: Metatarsal pronation has been claimed to be a risk factor for hallux valgus recurrence. A rounded shape of the lateral aspect of the first metatarsal head has been identified as a sign of persistent metatarsal pronation after hallux valgus correction. This study investigated the derotational effect of a reversed L-shaped (ReveL) osteotomy combined with a lateral release to correct metatarsal pronation. The primary hypothesis was that most cases showing a positive round sign are corrected by rebalancing the metatarsal-sesamoid complex. We further assumed that the inability to correct the round sign might be a risk factor for hallux valgus recurrence. Methods: We retrospectively evaluated 266 cases treated with a ReveL osteotomy for hallux valgus deformity. The radiologic measurements were performed on weightbearing foot radiographs preoperatively, at an early follow-up (median, 6.2 weeks), and the most recent follow-up (median, 13 months). Univariate and multivariate logistic regression analyses identified risk factors for hallux valgus recurrence (hallux valgus angle [HVA] ≥ 20 degrees). Results: A preoperative positive radiographic round sign was present in 40.2% of the cases, of which 58.9% turned negative after the ReveL osteotomy (P <.001). Hallux valgus recurred in 8.6%. Risk factors for recurrence were a preoperative HVA >30 degrees (odds ratio [OR] = 5.3, P <.001), metatarsus adductus (OR = 4.0, P =.004), preoperative positive round sign (OR = 3.3, P =.02), postoperative HVA >15 degrees (OR = 74.9; P <.001), and postoperative positive round sign (OR = 5.3, P =.008). Cases with a positive round sign at the most recent follow-up had a significantly higher recurrence rate than those with a negative round sign (22.7% vs 5.9%, P <.001). Conclusion: The ReveL osteotomy corrected a positive round sign in 58.9%, suggesting that not all hallux valgus deformities may need proximal derotation to negate the radiographic appearance of the round sign. A positive round sign was found to be an independent risk factor for hallux valgus recurrence. Further 3-dimensional analyses are necessary to better understand the effects and limitations of distal translational osteotomies to correct metatarsal pronation. Level of Evidence: Level IV, case series.
- Subjects
DISEASE relapse; FOOT radiography; FOOT anatomy; SESAMOID bones; PATIENT aftercare; FOOT abnormalities; OSTEOTOMY; PRONATION; MULTIVARIATE analysis; RETROSPECTIVE studies; HALLUX valgus; METATARSUS; BIOMECHANICS; DISEASE complications
- Publication
Foot & Ankle Orthopaedics, 2022, Vol 7, Issue 3, p1
- ISSN
2473-0114
- Publication type
Article
- DOI
10.1177/24730114221115697