Percutaneous osteotomy of the distal phalanx of the hallux. Indications and technique
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Published:
Apr 14, 2021
Keywords:
Phalangeal osteotomy, percutaneous surgery, hallux valgus, hallux deformity, MIS osteotomy
Main Article Content
Abstract
Introduction. There are many techniques to correct the hallux deformity. Most of them include metatarsal and/or phalanx osteotomies. The Akin osteotomy of the proximal phalanx is used to correct the distal articular set angle (DASA), or the interphalangeal angle. However, indications for the distal phalanx osteotomy remain unpublished. The aim of this study is to communicate the technique of performing and the indications for percutaneous osteotomy of the distal phalanx of the hallux, and evaluate the results of a cases series.
Materials and methods. We report 14 cases in which distal phalangeal osteotomy was performed. Radiographic measurements were performed on dorsal-plantar view foot, to analyze distal articular set angle (DASA), interphalangeal obliquity, and F2-IP angle. Surgical technique was performed by minimally incision surgery. The clinical and functional results were evaluate by the visual analogue scale pain, and the AOFAS score. Mean follow-up was 52 months.
Results. The clinical result for all the patients was excellent, pain was relieved and deformities corrected. Pre- and post-operative comparative angles: DASA (p: 0.01), except when isolated from the sample for Akin-type osteotomy (p: 0.33). Angle F2-IF and angle F2-MTF (p: <0.00001). The patients where highly satisfied with both the aesthetic and functional results. Complications were registered.
Conclusion. In the symptomatic hallux´s distal phalanx deformity a corrective distal phalanx osteotomy should be considered alone, or associated with the osteotomy of the proximal phalanx. Percutaneous distal phalanx osteotomy is an effective, safe, and fast procedure.
Level of Evidence: IV
Materials and methods. We report 14 cases in which distal phalangeal osteotomy was performed. Radiographic measurements were performed on dorsal-plantar view foot, to analyze distal articular set angle (DASA), interphalangeal obliquity, and F2-IP angle. Surgical technique was performed by minimally incision surgery. The clinical and functional results were evaluate by the visual analogue scale pain, and the AOFAS score. Mean follow-up was 52 months.
Results. The clinical result for all the patients was excellent, pain was relieved and deformities corrected. Pre- and post-operative comparative angles: DASA (p: 0.01), except when isolated from the sample for Akin-type osteotomy (p: 0.33). Angle F2-IF and angle F2-MTF (p: <0.00001). The patients where highly satisfied with both the aesthetic and functional results. Complications were registered.
Conclusion. In the symptomatic hallux´s distal phalanx deformity a corrective distal phalanx osteotomy should be considered alone, or associated with the osteotomy of the proximal phalanx. Percutaneous distal phalanx osteotomy is an effective, safe, and fast procedure.
Level of Evidence: IV
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How to Cite
Yañez Arauz, J. M., Yañez Arauz, J. M., Montiel Terrón, V., Machado, V., Alfonso, M., & Villas-Tomé, C. (2021). Percutaneous osteotomy of the distal phalanx of the hallux. Indications and technique. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(2), 139-150. https://doi.org/10.15417/issn.1852-7434.2021.86.1.1097
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Clinical Research
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References
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2. Myerson MS. Hallux valgus. En: Myerson MS (ed.). Foot and ankle disorders. Philadelphia: Saunders; 2000.
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PMID: 7797875
4. Coughlin MJ. Hallux valgus in men: Effect of the distal metatarsal articular angle on hallux valgus correction. Foot Ankle Int 1997;18(8):463-70. https://doi.org/10.1177/107110079701800802
5. Haines RW. Shoe design and toe deformation. Lancet 1954; 267(6852):1308-11. https://doi.org/10.1016/s0140-6736(54)90712-6
6. Lelievre J. Shoes and our foot. III. The physiological shoe. Concours Med 1961;83:1081-4. PMID: 13760672
7. Frey C, Thompson F, Smith J. Update on women’s footwear. Foot Ankle Int 1995;16(6):328-31.
https://doi.org/10.1177/107110079501600603
8. Craigmile DA. Incidence, origin, and prevention of certain foot defects. Br Med J 1953;2(4839):749-52.
https://doi.org/10.1136/bmj.2.4839.749
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12. Sorto Jr LA, Balding MG, Weil LS, Smith SD. Hallux abductus interphalangeus. Etiology, X-ray evaluation and
treatment. 1975. J Am Podiatr Med Assoc 1992;82(2):85-97. https://doi.org/10.7547/87507315-82-2-85
13. Akin OF. The treatment of hallux valgus-a new operative procedure and its results. Medical Sentinel 1925;33:678.
14. Hayes MHS, Patterson DG. Experimental development of the graphic rating method. Psychological Bulletin
1921;18:98-99.
15. Zealley AK, Aitken RCB. A growing edge of measurement of feelings [Abridged]: Measurement of mood. Proc R Soc Med 1969;62(10):993-6. PMID: 5346176
16. Mann R, Coughlin M. Hallux valgus y sus complicaciones. En: Cirugía del pie, 5ª ed. Buenos Aires: Editorial
Médica Panamericana; 1986.
17. Barnett CH. Valgus deviation of the distal phalanx of the great toe. J Anat 1962;96(Pt 2):171-7. PMID: 13865114
18. Bryant JA. A comparison of radiographic foot measurements taken in two different positions. J Am Podiatr Med Assoc 2001;91(5):234-9. https://doi.org/10.7547/87507315-91-5-234
19. Coughlin MJ, Shurnas PS. Hallux rigidus: demographics, etiology, and radiographic assessment. Foot Ankle Int 2003;24(10):731-43. https://doi.org/10.1177/107110070302401002
20. Sorto LA, Balding MG, Weil LS, Smith SD. Hallux abductus interphalangeus: etiology, x-ray evaluation and
treatment. J Am Podiatry Assoc 1976;66(6):384-96. https://doi.org/10.7547/87507315-66-6-384
21. Fitzgerald JA. A review of long-term results of arthrodesis of the first metatarso-phalangeal joint. J Bone Joint Surg Br 1969;51(3):488-93. PMID: 5820792
22. Barnett CH. The normal orientation of the human hallux and the effect of footwear. J Anat 1962;96(Pt 4):489-94. PMID: 13969386
23. Shimizu A, Watanabe S, Kamada K, Tsuboi I, Yamamoto H. Hallux valgus interphalangeus following osteochondral fracture of the proximal phalanx: a case report. Foot Ankle Int 2005;26(11):994-6.
https://doi.org/10.1177/107110070502601116
24. Carnevale V. Phalanx valga of the great toe (“phalanx valga hallucis”) or clinodactyly of the great toe. Prensa
Médica Argentina 1959;46:761-3.
25. Parrinello JF, Japour CJ, Dykyj D. Incurvated nail. Does the phalanx determine nail plate shape? J Am Podiatr Med Assoc 1995;85:696-8. https://doi.org/10.7547/87507315-85-11-696
26. Villas C, Del Rio J, Valenti A, Alfonso M. Symptomatic medial exostosis of the great toe distal phalanx: a
complication due to over-correction following Akin osteotomy for hallux valgus repair. J Foot Ankle Surg
2009;48(1):47-51. https://doi.org/10.1053/j.jfas.2008.08.011
27. Barouk LS, Barouk P, Baudet B, Toullec E. The great toe proximal phalanx osteotomy: the final step of the
bunionectomy. Foot Ankle Clin 2005;10(1):141-55. https://doi.org/10.1016/j.fcl.2004.09.006
28. Vander Griend R. Correction of hallux valgus interphalangeus with an osteotomy of the distal end of the proximal phalanx (distal Akin osteotomy). Foot Ankle Int 2017;38(2),153-8. https://doi.org/10.1177/1071100716670389
29. Burry HAS. The effect of shoes on hallux valgus: a significant study. Research Report 147: British Boot, Shoe and Allied Trades Research Association.
30. Valentí A, Montiel V, Alfonso M, Villas C. Feasibility of open and percutaneous corrective osteotomies of the
second phalanx of the great toe. An approach on a cadaveric model. Foot (Edinb) 2019;38:39-42.
https://doi.org/10.1016/j.foot.2018.12.001
2. Myerson MS. Hallux valgus. En: Myerson MS (ed.). Foot and ankle disorders. Philadelphia: Saunders; 2000.
3. Coughlin MJ, Thompson FM. The high price of high-fashion footwear. Instr Course Lect 1995;44:371-7.
PMID: 7797875
4. Coughlin MJ. Hallux valgus in men: Effect of the distal metatarsal articular angle on hallux valgus correction. Foot Ankle Int 1997;18(8):463-70. https://doi.org/10.1177/107110079701800802
5. Haines RW. Shoe design and toe deformation. Lancet 1954; 267(6852):1308-11. https://doi.org/10.1016/s0140-6736(54)90712-6
6. Lelievre J. Shoes and our foot. III. The physiological shoe. Concours Med 1961;83:1081-4. PMID: 13760672
7. Frey C, Thompson F, Smith J. Update on women’s footwear. Foot Ankle Int 1995;16(6):328-31.
https://doi.org/10.1177/107110079501600603
8. Craigmile DA. Incidence, origin, and prevention of certain foot defects. Br Med J 1953;2(4839):749-52.
https://doi.org/10.1136/bmj.2.4839.749
9. Coughlin MJ. Women’s shoe wear and foot disorders. West J Med 1995;163(6):569-70. https://doi.org/10.1177/107110079501600603
10. Coughlin MJ. Roger A. Mann Award. Juvenile hallux valgus: etiology and treatment. Foot Ankle Int 1995;16(11): 682-97. https://doi.org/10.1177/107110079501601104
11. Daw SW. An unusual type of hallus valgus (two cases). BMJ 1935; 2:580-2.
12. Sorto Jr LA, Balding MG, Weil LS, Smith SD. Hallux abductus interphalangeus. Etiology, X-ray evaluation and
treatment. 1975. J Am Podiatr Med Assoc 1992;82(2):85-97. https://doi.org/10.7547/87507315-82-2-85
13. Akin OF. The treatment of hallux valgus-a new operative procedure and its results. Medical Sentinel 1925;33:678.
14. Hayes MHS, Patterson DG. Experimental development of the graphic rating method. Psychological Bulletin
1921;18:98-99.
15. Zealley AK, Aitken RCB. A growing edge of measurement of feelings [Abridged]: Measurement of mood. Proc R Soc Med 1969;62(10):993-6. PMID: 5346176
16. Mann R, Coughlin M. Hallux valgus y sus complicaciones. En: Cirugía del pie, 5ª ed. Buenos Aires: Editorial
Médica Panamericana; 1986.
17. Barnett CH. Valgus deviation of the distal phalanx of the great toe. J Anat 1962;96(Pt 2):171-7. PMID: 13865114
18. Bryant JA. A comparison of radiographic foot measurements taken in two different positions. J Am Podiatr Med Assoc 2001;91(5):234-9. https://doi.org/10.7547/87507315-91-5-234
19. Coughlin MJ, Shurnas PS. Hallux rigidus: demographics, etiology, and radiographic assessment. Foot Ankle Int 2003;24(10):731-43. https://doi.org/10.1177/107110070302401002
20. Sorto LA, Balding MG, Weil LS, Smith SD. Hallux abductus interphalangeus: etiology, x-ray evaluation and
treatment. J Am Podiatry Assoc 1976;66(6):384-96. https://doi.org/10.7547/87507315-66-6-384
21. Fitzgerald JA. A review of long-term results of arthrodesis of the first metatarso-phalangeal joint. J Bone Joint Surg Br 1969;51(3):488-93. PMID: 5820792
22. Barnett CH. The normal orientation of the human hallux and the effect of footwear. J Anat 1962;96(Pt 4):489-94. PMID: 13969386
23. Shimizu A, Watanabe S, Kamada K, Tsuboi I, Yamamoto H. Hallux valgus interphalangeus following osteochondral fracture of the proximal phalanx: a case report. Foot Ankle Int 2005;26(11):994-6.
https://doi.org/10.1177/107110070502601116
24. Carnevale V. Phalanx valga of the great toe (“phalanx valga hallucis”) or clinodactyly of the great toe. Prensa
Médica Argentina 1959;46:761-3.
25. Parrinello JF, Japour CJ, Dykyj D. Incurvated nail. Does the phalanx determine nail plate shape? J Am Podiatr Med Assoc 1995;85:696-8. https://doi.org/10.7547/87507315-85-11-696
26. Villas C, Del Rio J, Valenti A, Alfonso M. Symptomatic medial exostosis of the great toe distal phalanx: a
complication due to over-correction following Akin osteotomy for hallux valgus repair. J Foot Ankle Surg
2009;48(1):47-51. https://doi.org/10.1053/j.jfas.2008.08.011
27. Barouk LS, Barouk P, Baudet B, Toullec E. The great toe proximal phalanx osteotomy: the final step of the
bunionectomy. Foot Ankle Clin 2005;10(1):141-55. https://doi.org/10.1016/j.fcl.2004.09.006
28. Vander Griend R. Correction of hallux valgus interphalangeus with an osteotomy of the distal end of the proximal phalanx (distal Akin osteotomy). Foot Ankle Int 2017;38(2),153-8. https://doi.org/10.1177/1071100716670389
29. Burry HAS. The effect of shoes on hallux valgus: a significant study. Research Report 147: British Boot, Shoe and Allied Trades Research Association.
30. Valentí A, Montiel V, Alfonso M, Villas C. Feasibility of open and percutaneous corrective osteotomies of the
second phalanx of the great toe. An approach on a cadaveric model. Foot (Edinb) 2019;38:39-42.
https://doi.org/10.1016/j.foot.2018.12.001