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Comparison of distal soft-tissue procedures combined with a distal chevron osteotomy for moderate to severe hallux valgus: first web-space versus transarticular approach.
J Bone Joint Surg Am. 2013 Nov 06; 95(21):e158.JB

Abstract

BACKGROUND

There are two surgical approaches for distal soft-tissue procedures for the correction of hallux valgus-the dorsal first web-space approach, and the medial transarticular approach. The purpose of this study was to compare the outcomes achieved after use of either of these approaches combined with a distal chevron osteotomy in patients with moderate to severe hallux valgus.

METHODS

One hundred and twenty-two female patients (122 feet) who underwent a distal chevron osteotomy as part of a distal soft-tissue procedure for the treatment of symptomatic unilateral moderate to severe hallux valgus constituted the study cohort. The 122 feet were randomly divided into two groups: namely, a dorsal first web-space approach (group D; sixty feet) and a medial transarticular approach (group M; sixty-two feet). The clinical and radiographic results of the two groups were compared at a mean follow-up time of thirty-eight months.

RESULTS

The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale hallux metatarsophalangeal-interphalangeal scores improved from a mean and standard deviation of 55.5 ± 12.8 points preoperatively to 93.5 ± 6.3 points at the final follow-up in group D and from 54.9 ± 12.6 points preoperatively to 93.6 ± 6.2 points at the final follow-up in group M. The mean hallux valgus angle in groups D and M was reduced from 32.2° ± 6.3° and 33.1° ± 8.4° preoperatively to 10.5° ± 5.5° and 9.9° ± 5.5°, respectively, at the time of final follow-up. The mean first intermetatarsal angle in groups D and M was reduced from 15.0° ± 2.8° and 15.3° ± 2.7° preoperatively to 6.5° ± 2.2° and 6.3° ± 2.4°, respectively, at the final follow-up. The clinical and radiographic outcomes were not significantly different between the two groups.

CONCLUSIONS

The final clinical and radiographic outcomes between the two approaches for distal soft-tissue procedures were comparable and equally successful. Accordingly, the results of this study suggest that the medial transarticular approach is an effective and reliable means of lateral soft-tissue release compared with the dorsal first web-space approach.

LEVEL OF EVIDENCE

Therapeutic level II. See Instructions for Authors for a complete description of levels of evidence.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, 42 Jebongro, Dong-gu, Gwangju, 501-757, Republic of Korea. E-mail address for K.-B. Lee: kbleeos@chonnam.ac.kr.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

24196470

Citation

Park, Yu-Bok, et al. "Comparison of Distal Soft-tissue Procedures Combined With a Distal Chevron Osteotomy for Moderate to Severe Hallux Valgus: First Web-space Versus Transarticular Approach." The Journal of Bone and Joint Surgery. American Volume, vol. 95, no. 21, 2013, pp. e158.
Park YB, Lee KB, Kim SK, et al. Comparison of distal soft-tissue procedures combined with a distal chevron osteotomy for moderate to severe hallux valgus: first web-space versus transarticular approach. J Bone Joint Surg Am. 2013;95(21):e158.
Park, Y. B., Lee, K. B., Kim, S. K., Seon, J. K., & Lee, J. Y. (2013). Comparison of distal soft-tissue procedures combined with a distal chevron osteotomy for moderate to severe hallux valgus: first web-space versus transarticular approach. The Journal of Bone and Joint Surgery. American Volume, 95(21), e158. https://doi.org/10.2106/JBJS.L.01017
Park YB, et al. Comparison of Distal Soft-tissue Procedures Combined With a Distal Chevron Osteotomy for Moderate to Severe Hallux Valgus: First Web-space Versus Transarticular Approach. J Bone Joint Surg Am. 2013 Nov 6;95(21):e158. PubMed PMID: 24196470.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of distal soft-tissue procedures combined with a distal chevron osteotomy for moderate to severe hallux valgus: first web-space versus transarticular approach. AU - Park,Yu-Bok, AU - Lee,Keun-Bae, AU - Kim,Sung-Kyu, AU - Seon,Jong-Keun, AU - Lee,Jun-Young, PY - 2013/11/8/entrez PY - 2013/11/8/pubmed PY - 2014/1/1/medline SP - e158 EP - e158 JF - The Journal of bone and joint surgery. American volume JO - J Bone Joint Surg Am VL - 95 IS - 21 N2 - BACKGROUND: There are two surgical approaches for distal soft-tissue procedures for the correction of hallux valgus-the dorsal first web-space approach, and the medial transarticular approach. The purpose of this study was to compare the outcomes achieved after use of either of these approaches combined with a distal chevron osteotomy in patients with moderate to severe hallux valgus. METHODS: One hundred and twenty-two female patients (122 feet) who underwent a distal chevron osteotomy as part of a distal soft-tissue procedure for the treatment of symptomatic unilateral moderate to severe hallux valgus constituted the study cohort. The 122 feet were randomly divided into two groups: namely, a dorsal first web-space approach (group D; sixty feet) and a medial transarticular approach (group M; sixty-two feet). The clinical and radiographic results of the two groups were compared at a mean follow-up time of thirty-eight months. RESULTS: The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale hallux metatarsophalangeal-interphalangeal scores improved from a mean and standard deviation of 55.5 ± 12.8 points preoperatively to 93.5 ± 6.3 points at the final follow-up in group D and from 54.9 ± 12.6 points preoperatively to 93.6 ± 6.2 points at the final follow-up in group M. The mean hallux valgus angle in groups D and M was reduced from 32.2° ± 6.3° and 33.1° ± 8.4° preoperatively to 10.5° ± 5.5° and 9.9° ± 5.5°, respectively, at the time of final follow-up. The mean first intermetatarsal angle in groups D and M was reduced from 15.0° ± 2.8° and 15.3° ± 2.7° preoperatively to 6.5° ± 2.2° and 6.3° ± 2.4°, respectively, at the final follow-up. The clinical and radiographic outcomes were not significantly different between the two groups. CONCLUSIONS: The final clinical and radiographic outcomes between the two approaches for distal soft-tissue procedures were comparable and equally successful. Accordingly, the results of this study suggest that the medial transarticular approach is an effective and reliable means of lateral soft-tissue release compared with the dorsal first web-space approach. LEVEL OF EVIDENCE: Therapeutic level II. See Instructions for Authors for a complete description of levels of evidence. SN - 1535-1386 UR - https://www.unboundmedicine.com/medline/citation/24196470/Comparison_of_distal_soft_tissue_procedures_combined_with_a_distal_chevron_osteotomy_for_moderate_to_severe_hallux_valgus:_first_web_space_versus_transarticular_approach_ L2 - https://doi.org/10.2106/JBJS.L.01017 DB - PRIME DP - Unbound Medicine ER -