PROCEDURE OF RECONSTRUCTING TRANSVERSE ARCH OF THE FOREFOOT BY TRANSFERING TENDONS FOR CORRECTING HALLUX VALGUS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANXingchao , LIUJianfeng , LIUBin ,  LIUZhigang , PANYuehai , JIAXiaoyan , ZHANGYanan , SHAOJiangbo

Department of Hand and Foot Surgery, the First Hospital of Jilin University, Changchun Jilin, 130021, P. R. China;

Corresponding?author：

LIUZhigang, Email: lzgn678@163.com

Keywords：

Hallux valgus; Transverse arch of forefoot; Adductor hallucis tendon; Abductor hallucis tendon

DOI：

10.7507/1002-1892.20150089

Video：

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Objective To explore the effectiveness of the procedure of reconstructing the transverse arch of the forefoot by anastomosing adductor hallucis and abductor hallucis tendons in correcting hallux valgus. Methods A retrospective analysis was made on the clinical data from 28 patients (40 feet) with hallux valgus treated with the procedure of reconstructing the transverse arch of the forefoot by anastomosing adductor hallucis and abductor hallucis tendons between January 2010 and January 2014. There were 3 males (6 feet) and 25 females (34 feet), with an average age of 51.7 years (range, 20-71 years). The unilateral foot was involved in 16 cases and bilateral feet in 12 cases. The mean disease duration was 8.9 years (range, 1-30 years). All the cases had pain of the first metacarpophalangeal joint; 22 feet had collapsed transverse arch of the forefoot combined with plantar callus, and 8 feet had collapsed transverse arch of the forefoot combined with hammer toe deformity. American Orthopaedic Foot and Ankle Society (AOFAS) score was 59.07±8.49. Preoperative X-ray showed that the hallux valgus angle (HVA) was (33.68±8.10)°, and the intermetatarsal angle (IMA) was (15.60±4.07)°. According to classification of the hallux valgus by Mann, 9 feet were rated as mild, 23 feet as moderate, and 8 feet as severe. Results Superficial infection of incision occurred in 1 case (1 foot) after surgery, and healing by first intention was obtained in the others. Two cases (3 feet) had numbness in the toes. All of 28 cases were followed up from 6 months to 4 years (1.8 years on average). Based on the AOFAS score, the results were excellent in 24 feet, good in 9 feet, fair in 4 feet, and poor in 3 feet, and the excellent and good rate was 82.5%. At last follow-up, the HVA, IMA, and AOFAS score were (15.10±5.28)°, (9.05±2.42)°, and 86.03±7.45 respectively, showing significant differences compared with preoperative ones (P=0.00). The collapsed transverse arch of the forefoot was recovered to some extent, plantar callus disappeared (14 feet), or decreased (8 feet). Recurrence of hallux valgus deformity was observed in 2 cases (3 feet) at 2 and 3 months after surgery respectively, and no hallux varus was found. Conclusion This procedure not only can effectively reduce the increased hallux valgus angle, and narrow the angle between the 1st and 2nd metatarsal, but also can relocate the sesamoid system, reconstruct the transverse arch of the forefoot, and effectively restore the physiological anatomy structure and biological function of the forefoot.

Citation： YANXingchao, LIUJianfeng, LIUBin, LIUZhigang, PANYuehai, JIAXiaoyan, ZHANGYanan, SHAOJiangbo. PROCEDURE OF RECONSTRUCTING TRANSVERSE ARCH OF THE FOREFOOT BY TRANSFERING TENDONS FOR CORRECTING HALLUX VALGUS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(4): 412-415. doi: 10.7507/1002-1892.20150089 Copy

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2.	Mortier JP, Bernard JL, Maestro M. Axial rotation of the first metatarsal head in a normal population and hallux valgus patients. Orthop Traumatol Surg Res, 2012, 98(6):677-683.
3.	郄淑燕, 張慶民, 張致媛, 等. 拇外翻對前足底壓力分布的改變. 醫學生物力學, 2010, 25(3):224-229.
4.	Suzuki J, Tanaka Y, Takaoka T, et al. Axial radiographic evaluation in hallux valgus:evaluation of the transverse arch in the forefoot. J Orthop Sci, 2004, 9(5):446-451.
5.	Yavuz M, Hetherington VJ, Botek G, et al. Forefoot plantar shear stress distribution in hallux valgus patients. Gait Posture, 2009, 30(2):257-259.
6.	Galica AM, Hagedorn TJ, Dufour AB, et al. Hallux valgus and plantar pressure loading:the Framingham foot study. J Foot Ankle Res, 2013, 6(1):42.
7.	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, 3:1-9.
8.	厲亞男, 王湘達, 王英振, 等. 改良型McBride矯形手術治療足拇外翻的效果.青島大學醫學院學報, 2014, 50(6):552-554.
9.	王玉發, 高明, 馬洪順. 拇展肌與拇收肌移位吻接術前、后黏彈性實驗研究. 北京生物醫學工程, 2007, 26(5):535-539.
10.	王正義. 足踝外科學. 北京:人民衛生出版社, 2007:465-466.
11.	S.Terry Canale, James H. Beaty. 坎貝爾骨科手術學. 王巖, 譯. 北京:人民軍醫出版社, 2013:3539-3591.
12.	戴鶴玲, 溫建民, 孫天勝, 等. 拇趾外翻足臨床療效評價標準. 中國骨與關節損傷雜志, 2010, 25(12):1151-1152.
13.	史思峰, 董揚. 拇外翻主要病理改變及組織修復方法的選擇. 中國組織工程研究與臨床康復, 2009, 13(50):9958-9961.
14.	Perera AM, Mason L, Stephens MM. The pathogenesis of hallux valgus. J Bone Joint Surg (Am), 2011, 93(17):1650-1661.
15.	Iaremenko DA. Methods of study of the "transverse arch"of the foot. Orthop Trauma Protez, 1967, 28(2):20-24.
16.	鮑根喜, 王旭, 夏新雷, 等. 正常足步態周期中動態足橫弓形態的初步分析.中國矯形外科雜志, 2001, 8(4):375-377.
17.	Simonsen O, Vuust M, Understrup B, et al. The transverse forefoot arch demonstrated by a novel X-ray projection. Foot and Ankle Surgery, 2009, 15(1):7-13.
18.	鮑根喜, 王旭, 顧湘杰, 等. 足橫弓形態的動態分析與外翻的關系研究. 中華骨科雜志, 2001, 21 (3):134-136.
19.	宋朝暉, 張英澤, 張奉琪, 等. 正常足與外翻足橫弓形態的對比性研究. 中國矯形外科雜志, 2005, 13(24):1873-1875.
20.	馬昕, 顧湘杰, 陳勁松, 等. 正常足與外翻足的足橫弓三維形態比較. 中華骨科雜志, 1998, 18(5):274-277.
21.	石凱, 劉志剛. "跖袖"的解剖學特點及臨床意義. 中國臨床解剖學雜志, 2007, 25(3):266-271.
22.	張英澤, 張奉琪, 韓久卉, 等. 長伸肌腱移位動力性矯正外翻畸形. 中國修復重建外科雜志, 2007, 21(11):1171-1174.

1. Collan L, Kankare JA, Mattila K. The biomechanics of the first metatarsal bone in hallux valgus:a preliminary study utilizing a weight bearing extremity CT. Foot Ankle Surg, 2013,19(3):155-161.
2. Mortier JP, Bernard JL, Maestro M. Axial rotation of the first metatarsal head in a normal population and hallux valgus patients. Orthop Traumatol Surg Res, 2012, 98(6):677-683.
3. 郄淑燕, 張慶民, 張致媛, 等. 拇外翻對前足底壓力分布的改變. 醫學生物力學, 2010, 25(3):224-229.
4. Suzuki J, Tanaka Y, Takaoka T, et al. Axial radiographic evaluation in hallux valgus:evaluation of the transverse arch in the forefoot. J Orthop Sci, 2004, 9(5):446-451.
5. Yavuz M, Hetherington VJ, Botek G, et al. Forefoot plantar shear stress distribution in hallux valgus patients. Gait Posture, 2009, 30(2):257-259.
6. Galica AM, Hagedorn TJ, Dufour AB, et al. Hallux valgus and plantar pressure loading:the Framingham foot study. J Foot Ankle Res, 2013, 6(1):42.
7. 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, 3:1-9.
8. 厲亞男, 王湘達, 王英振, 等. 改良型McBride矯形手術治療足拇外翻的效果.青島大學醫學院學報, 2014, 50(6):552-554.
9. 王玉發, 高明, 馬洪順. 拇展肌與拇收肌移位吻接術前、后黏彈性實驗研究. 北京生物醫學工程, 2007, 26(5):535-539.
10. 王正義. 足踝外科學. 北京:人民衛生出版社, 2007:465-466.
11. S.Terry Canale, James H. Beaty. 坎貝爾骨科手術學. 王巖, 譯. 北京:人民軍醫出版社, 2013:3539-3591.
12. 戴鶴玲, 溫建民, 孫天勝, 等. 拇趾外翻足臨床療效評價標準. 中國骨與關節損傷雜志, 2010, 25(12):1151-1152.
13. 史思峰, 董揚. 拇外翻主要病理改變及組織修復方法的選擇. 中國組織工程研究與臨床康復, 2009, 13(50):9958-9961.
14. Perera AM, Mason L, Stephens MM. The pathogenesis of hallux valgus. J Bone Joint Surg (Am), 2011, 93(17):1650-1661.
15. Iaremenko DA. Methods of study of the "transverse arch"of the foot. Orthop Trauma Protez, 1967, 28(2):20-24.
16. 鮑根喜, 王旭, 夏新雷, 等. 正常足步態周期中動態足橫弓形態的初步分析.中國矯形外科雜志, 2001, 8(4):375-377.
17. Simonsen O, Vuust M, Understrup B, et al. The transverse forefoot arch demonstrated by a novel X-ray projection. Foot and Ankle Surgery, 2009, 15(1):7-13.
18. 鮑根喜, 王旭, 顧湘杰, 等. 足橫弓形態的動態分析與外翻的關系研究. 中華骨科雜志, 2001, 21 (3):134-136.
19. 宋朝暉, 張英澤, 張奉琪, 等. 正常足與外翻足橫弓形態的對比性研究. 中國矯形外科雜志, 2005, 13(24):1873-1875.
20. 馬昕, 顧湘杰, 陳勁松, 等. 正常足與外翻足的足橫弓三維形態比較. 中華骨科雜志, 1998, 18(5):274-277.
21. 石凱, 劉志剛. "跖袖"的解剖學特點及臨床意義. 中國臨床解剖學雜志, 2007, 25(3):266-271.
22. 張英澤, 張奉琪, 韓久卉, 等. 長伸肌腱移位動力性矯正外翻畸形. 中國修復重建外科雜志, 2007, 21(11):1171-1174.

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Chinese Journal of Reparative and Reconstructive Surgery

PROCEDURE OF RECONSTRUCTING TRANSVERSE ARCH OF THE FOREFOOT BY TRANSFERING TENDONS FOR CORRECTING HALLUX VALGUS

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