Analysis Of Clinic Parameters And Surgical Method In Hallux Valgus And Its Molecular Etiology Research With Bone Disease

Background and objective: Although various radiographic measurements have been developed and used for evaluating hallux valgus, not all are universally believed to be necessary and their relationships have not been clearly established. Determining which are related could provide some insight into which might be useful and which would not. We investigated the reliability of eight radiographic measurements used to evaluate hallux valgus, and determined which were correlated and which predicted the hallux valgus angle.Methods: We determined eight radiographic indices for 425 patients(mean age, 49.3 years; 95 males and 330 females) with hallux valgus: hallux valgus angle, intermetatarsal angle, hallux interphalangeal angle, distal metatarsal articular angle, proximal phalangeal articular angle, simplified metatarsus adductus angle, first metatarsal protrusion distance, and sesamoid rotation angle. Intraobserver and interobserver reliabilities of each radiographic measurement were analyzed on 36 feet from 36 randomly selected patients. Correlations among the radiographic measurements were analyzed. Radiographic measurements predicting hallux valgus angle were evaluated using multiple regression analysis.Results: Hallux valgus angle had the highest reliability, whereas the distal metatarsal articular angle and simplified metatarsus adductus angle had the lowest. Distal metatarsal articular angle, intermetatarsal angle, and sesamoid rotation angle had the highest correlations with hallux valgus angle. Distal metatarsal articular angle correlated with sesamoid rotation angle. The intermetatarsal angle, interphalangeal angle, distal metatarsal articular angle, first metatarsal protrusion distance, sesamoid rotation angle, and metatarsus adductus angle predicted the hallux valgus angle.Conclusions: We suggest using hallux valgus angle, intermetatarsal angle,interphalangeal angle, sesamoid rotation angle, and first metatarsal protrusion distance considering their reliability and prediction of the deformity.Background and objective: Hallux valgus is a common desease in clinic. Usually, patents complain about walking pain. Up to now, more than 130 surgical treatments on hallux valgus have been published. As each of them has their own indication, the outcome is still uncertained, especially after long-term follow-up. Thus, in this study, two noval surgical methods were applied in the treatment on moderate and severe hallux valgus. The outcome was analyzed.Methods: From November, 2009 to July, 2013, 30 patients(51 feet) with moderate or severe hallux valgus were treated by Ilizarov external fixator after first metatarsal osteotomy. 50 patients(81 feet) with moderate or severe hallux valgus were treated by T-miniature titanium plate internal fixation after Z-osteotomy distal to the first metatarsal. X-rays were taken until getting satisfied callus and outward appearance.Results: After follow-up for 3-36 months, the hallux valgus angle(HVA) was reduced by 11-23(mean, 13.9) degree, the intermetatarsal angle(IMA) was reduced by 5-10(mean, 7.2) degree, and 43 feet reached to the excellent level and 8 feet reached to the good level. According to the Maryland foot function scoring system of American Orthopedic Foot and Ankle Society(AOFAS), 122 feet obtained 90-100 scores, and 10 feet had 80-89 scores. The rate of excellent and good reached 100%. No infection was found and no deformity recurred. Bone union was obtained at osteotomy site. All patients were satisfied with good walking function.Conclusions: The efficacy of treatment on moderate and severe hallux valgus using the Ilizarov technique and osteotomy proximal to hallux sac combining with miniature titanium plate internal fixation are reliable and worthy of promotion.Background and Objective: Multiple osteochondromas(MO), an autosomal dominant skeletal disease, is characterized by the presence of multiple cartilage-capped bone tumors(exostoses). The incidence of MO has been estimated to be 1-2/100000. Exostoses develop after birth and progress gradually in size and number till skeletal maturity is achieved. In MO patients, the exostoses can appear in several joints and at multiple sites in the same joint. Various deformities including hallux valgus will be the clinical manifestations. The two genes with mutations that are most commonly associated with MO have been identified as EXT1 and EXT2, which are Exostosin-1 and Exostosin-2. In this study, a variety of EXT1 and EXT2 gene mutations were identified in one Chinese family with MO.Methods: We investigated 5 patients in the same family who exhibited the typical features of MO. We used PCR to analyze mutations and performed gene sequencing among patients, other normal members of the families and the control group which included 250 volunteers(male: 125, female: 125) without MO and hallux valgus. The radiological investigation was conducted simultaneously.Results: One nonsense mutation in exon 1 of EXT1, p.Gln27X(c.79C>T), was identified in the proband. We did not detect EXT2 gene mutation in the patients of family. Also, EXT1 or EXT2 gene mutations were not found in the unaffected family members or in the 250 healthy volunteers.Conclusions: We found that the EXT1 gene mutation: p.Gln27 X, was a novel mutation, which was responsible for MO associated with hallux valgus in our patients. Our findings are useful for extending the mutational spectrum in EXT1 and understanding the genetic basis of MO in Chinese patients and may contribute to the early molecular diagnosis and treatment of MO.