Medium and Long Term Results of Modified Lindgren-Turan Osteotomy in the Treatment of Moderate and Severe Hallux Valgus

Abstract

Purpose: The aim of this study is to evaluate the clinical and radiologic outcomes of patients with moderate to severe hallux valgus (HV) who underwent capsuloplasty and buniectomy with Lindgren-Turan osteotomy. Materials and Methods: The outcomes of 71 patients who underwent Modified Lindgren-Turan procedure were evaluated in the medium and long term. Clinically, assessment was done using the American Orthopaedic Foot and Ankle Society (AOFAS) score and Visual Analog Scale (VAS). Radiologically, preoperative and postoperative measurements of hallux val-gus angle (HVA), distal metatarsal angle (DMAA), first-second intermetatarsal angle (IMA), and first metatarsal shortening were evaluated using X-ray. Patients with moderate (n=52) and severe (n=19) hallux valgus were divided into two groups. Results: The patients were followed up for an average of 52.76 ± 9.7 months (range: 38-78 months). Patients were divided into two groups: moderate HV (group 1) and severe HV (group 2). In both groups, statistically significant improvements were observed in HVA, IMA, and DMAA values (p < 0.001). There was a shortening observed in the first metatarsal in both groups, but no significant difference was found between the groups (p = 0.342). Clinically, significant improvements were also noted in AOFAS and VAS scores in both groups (p < 0.001). Conclusion: The Modified Lindgren-Turan osteotomy causes mild shortening of the metatarsal, which does not lead to any compli-cations. With this method, moderate and severe hallux valgus deformities can be corrected, and favorable clinical and radiological outcomes can be achieved.

Keywords

• hallux valgus
• lindgren-turan osteotomy
• metatarsalgia

Orta ve Şiddetli Halluks Valgus Tedavisinde Modifiye Lindgren-Turan Osteotomisinin Orta ve Uzun Dönem Sonuçları

Abstract

Amaç: Bu çalışmada amaç, Lindgren-Turan osteotomisi ile beraber kapsüloplasti ve bunyonektomi uygulanan orta ve şiddetli halluks valguslu (HV) hastaların klinik ve radyolojik sonuçlarını değerlendirmektir. Araçlar ve Yöntem: Modifiye Lindgren-Turan prosüdürü uygulanan 71 hastanın orta ve uzun dönem sonuçları değerlendirilmiştir. Klinik olarak American Orthopaedic Foot and Ankle Society (AOFAS) ve Visual Analog Skala (VAS) ile değerlendirilirken, radyolojik olarak röntgenogram ile ameliyat öncesi ve sonrası halluks valgus açısı (HVA), distal metatarsal eklem açısı (DMAA), 1. ve 2. Metatars arası (İMA) açı ve birinci metatars kısalıkları değerlendirilmiştir. Orta (n=52) ve şiddetli (n=19) HV’lu hastalar 2 gruba ayrılmıştır. Bulgular: Hastalar, orta derece HV (grup 1) ve şiddetli HV (grup 2) olarak iki gruba ayrıldı. Her iki grupta HVA, İMA ve DMAA değerlerinde istatiksel olarak anlamlı bir düzelme tespit edildi (p<0.001). Gruplar arasında, birinci metatarslarda kısalık meydana geldi, ancak anlamlı bir fark olmadığı tespit edildi (p=0.342). Her iki grupta, klinik olarak AOFAS ve VAS değerlerinde istatiksel olarak anlamlı bir düzelme tespit edildi ( p<0.001). Sonuç: Modifiye Lindgren-Turan osteotomisi, orta ve şiddetli HV tedavisinde hafif metatars kısalığına neden olmakla beraber buna bağlı olarak herhangi bir komplikasyona yol açmamaktadır. Bu metot ile orta ve şiddetli deformiteler düzeltilebilmekte, klinik ve radyolojik olarak iyi sonuçlar elde edilebilmektedir.

Keywords

• halluks valgus
• lindgren-turan osteotomisi
• metatarsalji

References

1. 1. Nix S, Smith M, Vicenzino B. Prevalence of hallux valgus in the general population: a systematic review and meta-analysis. J. Foot Ankle Res. 2010;3(21):1-9.
2. 2. Easley ME, Trnka HJ. Current concepts review: hallux valgus part 1: pathomechanics, clinical assessment, and nonoperative management. Foot Ankle Int. 2007;28(5):654-659.
3. 3. Hecht PJ, Lin TJ. Hallux valgus. Medical Clinics. 2014;98(2):227-232.
4. 4. Heıneman N, Liu G, Pacicco T, Dessouky R, Wukich DK, Chhabra A. Clinical and imaging assessment and treatment of hallux valgus. Acta radiol. 2020;61(1): 56-66.
5. 5. Easley ME, Trnka HJ. Current concepts review: hallux valgus part II: operative treatment. Foot Ankle Int. 2007;28(6):748-758.
6. 6. Grace D, Hughes J, Klenerman L. A comparison of Wilson and Hohmann osteotomies in the treatment of hallux valgus. J Bone Joint Surg Br. 1988;70(2):236-241.
7. 7. Ferrari J, Higgins JP, Prior TD. Interventions for treating hallux valgus (abductovalgus) and bunions. Cochrane Database Syst Rev. 2004;(1): CD000964.
8. 8. Cassinelli SJ, Herman R, Harris TG. Distal metatarsal osteotomy for moderate to severe hallux valgus. Foot Ankle Int. 2016;37(10):1137-1145.

9. 9. Deenik AR, Enrico V, Louwerens JWK, et al. Hallux valgus angle as main predictor for correction of hallux valgus. BMC Musculoskelet. Disord. 2008;9(70):1-6.
10. 10. Burns PR, Mecham B. Biodynamics of hallux abductovalgus etiology and preoperative evaluation. Clin. Podiatr. Med. Surg. 2014;31(2):197-212.
11. 11. Everhart JS. Hallux Valgus Correction: The Best Technique Is Still Up for Debate: Commentary on an article by Alexej Barg, MD, et al.: "Unfavorable Outcomes Following Surgical Treatment of Hallux Valgus Deformity. A Systematic Literature Review". J Bone Joint Surg Am. 2018;100(18):e124.
12. 12. Klosok JK, Pring DJ, Jessop JH, Maffulli N. Chevron or Wilson metatarsal osteotomy for hallux valgus. A prospective randomised trial. J Bone Joint Surg Br. 1993;75(5):825-829.
13. 13. Chuckpaıwong B. Comparing proximal and distal metatarsal osteotomy for moderate to severe hallux valgus. Int. Orthop. 2012;36:2275-2278.
14. 14. Okuda R, Tanaka K, Shima H. Proximal Supination Osteotomy for Hallux Valgus: Comparison of Clinical and Radiologic Outcomes for the Most Severe Deformities. Foot Ankle Int. 2024;45(2):141-149.
15. 15. Park HW, Lee KB, Chung JY, Kim MS. Comparison of outcomes between proximal and distal chevron osteotomy, both with supplementary lateral soft-tissue release, for severe hallux valgus deformity: a prospective randomised controlled trial. The Bone & Joint J. 2013;95(4):510-516.
16. 16. Lee KB, Cho NY, Park HW, Seon JK, Lee SH. A comparison of proximal and distal Chevron osteotomy, both with lateral soft-tissue release, for moderate to severe hallux valgus in patients undergoing simultaneous bilateral correction: a prospective randomised controlled trial. The Bone & Joint J. 2015;97(2):202-207.
17. 17. Bai LB, Lee KB, Seo CY, Song EK, Yoon TR. Distal chevron osteotomy with distal soft tissue procedure for moderate to severe hallux valgus deformity. Foot Ankle Int. 2010;31(8):683-688.
18. 18. Deenik A, Mameren H, Visser E, Malefijt MW, Draijer F, Bie R. Equivalent correction in scarf and chevron osteotomy in moderate and severe hallux valgus: a randomized controlled trial. Foot Ankle Int. 2008;29(12): 1209-1215.
19. 19. Shih KS, Hsu CC, Huang GT. Biomechanical Investigation of Hallux Valgus Deformity Treated with Different Osteotomy Methods and Kirschner Wire Fixation Strategies Using the Finite Element Method. Bioeng. 2023;10(4):499.
20. 20. Bayraktar TO, Yüce A, Yerli M, Tekin AC, Gürbüz H. Distal metatarsal osteotomy and dorsal neutralization plate in the treatment of hallux valgus. Eur. J. Orthop. Surg. Traumatol. 2022;32:1-6.
21. 21. Bilgin E, Keçeci T, Turgut A, Adiyeke L, Kilinc BE. Comparison of Clinical and Radiological Results of Two Fixation Materials after Distal Chevron Osteotomy for Hallux Valgus? Two Kirschner Wires versus Single Screw Fixation. Acta Chir. Orthop. Traumatol. Cech. 2020;87(5):350-355.
22. 22. Şenocak E, Altay N, Demir M, Aygün U. (2023). Comparison of cannulated screw and kirschner wire in the chevron osteotomy of hallux valgus. Med. J. İslamic World Acad. Sci. 2023;30(1):56-60.
23. 23. Lindgren U, Turan İ. A new operation for hallux valgus. Clin Orthop Relat Res. 1983;175(1976-2007): 179-183.
24. 24. Özkan NK, Güven M, Akman B, Çakar M, Konal A, Turhan Y. Transosseous capsuloplasty improves the outcomes of Lindgren–Turan distal metatarsal osteotomy in moderate to severe hallux valgus deformity. Arch. Orthop. Trauma Surg. 2010;130:1201-1207.
25. 25. Maceira E, Monteagudo M. Transfer metatarsalgia post hallux valgus surgery. Foot Ankle Clin. 2014;19 (2):285-307.
26. 26. Glazebrook M, Copithorne P, Boyd G, et al. Proximal opening wedge osteotomy with wedge-plate fixation compared with proximal chevron osteotomy for the treatment of hallux valgus: a prospective, randomized study. J Bone Joint Surg Am. 2014;96(19):1585-1592.
27. 27. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994;15(7):349-353.
28. 28. Thordarson D, Ebramzadeh E, Moorthy M, Lee J, Rudicel S. Correlation of hallux valgus surgical outcome with AOFAS forefoot score and radiological parameters. Foot Ankle Int. 2005;26(2):122-127.
29. 29. Goldberg A, Singh D. Treatment of shortening following hallux valgus surgery. Foot Ankle Clin. 2014;19(2):309-316.
30. 30. Kaipel M, Krapf D, Wyss C. Metatarsal length does not correlate with maximal peak pressure and maximal force. Clin Orthop Relat Res. 2011;469:1161-1166.
31. 31. Kılınç BE, OC Y, Ertürer RE. Modified lindgren-turan osteotomy for hallux valgus deformity-a review of 60 cases. Acta Chir Orthop Traumatol Cech. 2018;85(5): 325-330.
32. 32. Uygur E, Özkan NK, Akan K, Çift H. A comparison of Chevron and Lindgren-Turan osteotomy techniques in hallux valgus surgery: a prospective randomized controlled study. Acta Orthop Traumatol Turc. 2016;50(3): 255-261.