First metatarsophalangeal joint fusion is a commonly used procedure for treating many pathologic disorders of the first ray. Historically, hallux valgus deformity with severely increased intermetatarsal angle or metatarsus primus adductus indicated need for a proximal metatarsal procedure. However, the effectiveness and reliability of first metatarsophalangeal joint arthrodesis in reducing the intermetatarsal angle has been increasingly described in the literature. We compared findings at our institution with current literature for further validation of this well-accepted procedure in correcting hallux valgus deformity with high intermetatarsal angle.
Weightbearing preoperative and postoperative radiographs of 43 patients, 31 women and 12 men, meeting the inclusion and exclusion criteria were identified. Two independent investigators measured the hallux abductus and intermetatarsal angles. Preoperative and postoperative measurements for each angle were compared and average reduction calculated. The data were further analyzed by grouping deformities as mild, moderate, and severe. Mean follow-up was 10 months.
The overall mean preoperative intermetatarsal and hallux abductus angles decreased significantly (from 13.09° to 9.33° and from 23.72° to 12.19°, respectively; both P < .01). When grouping deformities as mild, moderate, and severe, all of the categories maintained reduction of intermetatarsal and hallux abductus angles (P < .01). Furthermore, the mean reduction of the intermetatarsal and hallux abductus angles seemed to correlate with preoperative deformity severity.
In patients undergoing correction of hallux valgus deformity, first metatarsophalangeal joint arthrodesis produced consistent reductions in the intermetatarsal and hallux abductus angles. Furthermore, these findings are consistent with those reported by other institutions.
Background: Along with significant case transmission, hospitalizations, and mortality experienced during the global Sars-CoV-2 (COVID-19) pandemic, there existed a disruption in the delivery of health care across multiple specialties. We studied the effect of the pandemic on inpatients with diabetic foot problems in a level-one trauma center in Central Ohio. Methods: A retrospective chart review of patients necessitating a consultation by the foot and ankle surgery service were reviewed from the first 8 months of 2020. A total of 270 patients met the inclusion criteria and divided into pre-pandemic (n = 120) and pandemic groups (n = 150). Demographics, medical history, severity of current infection, and medical or surgical management were collected and analyzed.Results: The odds of undergoing any level of amputation was 10.8 times higher during the pandemic versus before the pandemic. The risk of major amputations (below-the-knee or higher) likewise increased with an odds ratio of 12.5 among all patients in the foot and ankle service during the pandemic. Of the patients undergoing any amputation, the odds for receiving a major amputation was 3.1 times higher than before the pandemic. Additionally, the severity of infections increased during the pandemic and a larger proportion of the cases were classified as emergent in the pandemic group compared to the pre-pandemic group.Conclusions: The effect of the pandemic on the health-care system has had a deleterious effect on people with diabetes-related foot problems resulting in more severe infections, more emergencies, and necessitating more amputations. When an amputation was performed, the likelihood it was a major amputation also increased.Editor's Note: This Original Article accompanies "Diabetes-Related Amputations: A Pandemic within a Pandemic," by Lee C. Rogers, DPM, Robert J. Snyder, DPM, and Warren S. Joseph, DPM, FIDSA, available at https://doi.org/10.7547/20-248