Clinical Research Of 4 Kinds Of Operation For Hallux Valgus

Purpose:Hallux Valgus is a common clinical disease with high incidence rate,especially for female.It may reach 50%in some countries.Conservative treatment includes wearing wide shoes,using brace,etc.As early as the end of 18th century surgery has been widely noticed but no specific method can be applied.Until the beginning of 20^th century Keller operation begins to be the main surgery for Hallux Valgus.After that there are many kinds of operational methods for hallux valgus.More than 200 methods are recorded in papers.Most of them are not applicable for to provide more perception in curing Hallux Valgus clinically,clinic for the disadvantage is over the advantage.Based on previous anatomy and clinic research we further evaluate the result of the 4 commonly used operation methodsMethods:Study treatment for 106 patients with 116 feet with hallux valugs respectively with:1) Mayo operation(removal of the inner osleophyma of the metatarsus head,contraction of 1st metatarsal articular capsule) 2) improved Mcbride operation(release of adductor hallucis, excision of lateral sesamoid,removal of inner osleophyma,relax of outer joint capsule,and contraction of inner joint capsule) 3) Keller operation(combining soft tissue release,and the removal of the medial eminence with resection of the proximal end of the proximal phalanx) 4) improved Mcbride operation with 1st metatarsal Osteotomy(Mcbrige and wedge osteotomy of the first metatarsal basis or metatarsal head corrective osteotomy).The patients were followed up for average of 18 months to compare and analysis the Hallux valgus angle(HVA), intermetatarsal angle(IMA),and partial symptom and feet function.Result:Mayo operation reaches 31.25%satisfaction rate,improved Mcbride operation reaches 92%,Keller operation reaches 86.2%,and improved Mcbrice operation with 1st metatarsal Osteotomy reaches 95.23%.After verify with x listχ² test,it has statistics meaning.Conclusion:Pre-operation planning based on the Hallux valgus angle(HVA), intermetatarsal angle(IMA),Hallus retrogression degree,and age of patients to choose the most suitable operation method is the key to the successful treatment.Careful operation during the surgery,and post-operation systematic fixation and functional exercise can maximally avoid recurrence and complication of the deformityKeller operation:It has no correction for metatarsus varus so it is not applicable for patients with extreme metatarsus varus.It suits elderly and weak patients with severe hallux valgus,especially for those with obvious metatarsophalangeal joint osteoarthritis.Improved Mcbride operation:It suits patients with slight hallux valgus,HVA between 18°to 36°,IMA between 10°and 18°,without obvious metatarsophalangeal joint osteoarthritis.Mayo operation:It suits patients with bunion,1st metatarsal hyperosteogeny and slight hallux valgus.It is not preferable for patients with severe hallux valgus,and severely bent 1st metatarsal,or hallux metatarsus osteoarthritis.Improved Mcbride operation with 1st metatarsal Osteotomy:It suits young patients with moderate to severe deformities,HVA between 30°and 50°,IMA between 18°and 24°,no 1st metatarsal joint osteoarthritis.