Outcomes of Hallux Valgus Correction Surgery
Condition: Hallux Valgus
MeSH terms: Hallux Valgus; Bunion
Study type: Interventional

Summary: 
      HV correction surgery using SERI appear to sufficiently reduce the severity of HV deformity
      in all radiological measurements (HVA, IMA, DMAA) and the correction of subluxation of the
      first MTP joint and the sesamoids. SERI technique is an easy, inexpensive, less invasive,
      more cosmetic, with shorter operative time and with minimal complication rates.

      To our knowledge, there is no report regarding HV treatment using SERI from Saudi Arabia or
      in any part of the Middle East. Therefore, this study conducted to determine the radiological
      measurements done preoperatively and compare the measurements done at one year
      postoperatively, recording the complication happened and measuring the cost effectiveness of
      such procedure.
    

Detailed description: 
      Hallux valgus (HV) is defined as a complex deformity where there is a lateral deviation of
      the proximal phalanx on the first metatarsal head (hallux) that is frequently associated with
      medial deviation of the first metatarsal, which may sometimes be accompanied by a significant
      functional disability and foot pain. Worldwide estimates from reports show a prevalence of
      23% among adults below 65 years old and 35.7% among adults >65 years old, higher among
      females, and directly proportional to increasing age.

      Because of the concomitant pain and other functional disability with HV, surgery is indicated
      usually depending on the degree of deformity based on the radiological findings as well as
      the physical examination findings. Radiological assessment includes weight-bearing
      anteroposterior (AP) and lateral imaging of the foot. The severity of the deformity is
      usually classified as mild, when the hallux valgus angle (HVA) is up to 19o , intermetatarsal
      angle (IMA) up to 13o; moderate when HVA is 20o to 40o; and severe when HVA is >40o and IMA
      >20o.

      There were a multitude of modern concepts in the surgical treatment of HV, including the
      Keller's procedure, the distal soft-tissue procedure, osteotomies of the first metatarsal,
      distal metatarsal osteotomies (Wilson procedure, Mitchell osteotomy, distal Chevron
      osteotomy), and many other type of surgeries including diaphyseal osteotomies and
      arthrodesis. Most of these surgical procedures were shown to provide morphologic and
      functional re-balance after surgery. While there are more than 150 surgical procedures
      described to treat HV, none of them is considered as a gold standard and each one had it is
      own advantages and disadvantages.

      Minimally invasive techniques for correction of HV include arthroscopy, percutaneous and
      minimum incision surgery which were found to provide better outcome by decreasing recovery
      and rehabilitation time. On the other hand, some authors suggested that to correct HV
      deformity using SERI, a lateral soft tissue release should be performed first and reposition
      the sesamoids to avoid recurrence of the HV.

      The SERI technique (as abbreviated to stand for simple, effective, rapid and inexpensive) was
      presented by several authors to be a minimally invasive technique since it presents with the
      same advantages as the percutaneous techniques with less tissue dissection and a need for
      only temporary hardware, meaning no instrumentation and surgery is performed under direct
      vision without fluoroscopy. It is a type of distal first metatarsal osteotomy. Several
      studies using SERI have shown adequate correction of the deformity without avascular necrosis
      of the metatarsal head, pseudoarthrosis or recurrence.

      Radiographic assessment including angular radiological parameters, sesamoid subluxation, and
      the articular congruency were shown to prove adequate correction of angular HV deformities.
      Preoperatively, measuring the axial view of the sesamoid position in the radiographic
      assessment of HV was proven to guide the surgeon on the appropriate surgical technique.
      Furthermore, measurements of the HVA and the IMA were recommended to evaluate preoperative
      assessment of the severity of HV and postoperative outcome of surgical treatment of HV.
    

Intervention name(s): a minimally invasive surgery (SERI)
Intervention type(s): Procedure
Intervention description(s): The SERI technique (as abbreviated to stand for simple, effective, rapid and inexpensive) was presented by several authors to be a minimally invasive technique since it presents with the same advantages as the percutaneous techniques with less tissue dissection and a need for only temporary hardware, meaning no instrumentation and surgery is performed under direct vision without fluoroscopy
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: SERI; correction surgery; Complications; radiological; outcomes