Chayanin Angthong1, Supakit Kanitnate, Wirana Angthong. 1. Department of Orthopaedic Surgery, Faculty of Medicine, Thammasat Hospital. Thammasat University, Pathum Thani, Thailand. chatthara@yahoo.com
Abstract
OBJECTIVE: Bony works seems to be base procedure for hallux valgus correction. Due to the challenge and possible complications of these procedures, these issues generate 'Foot and Ankle Society' to consider alternative procedures. The 'Mini TightRope' (Arthrex, Inc., Naples, FL) or interrosseous suture/button device was introduced in 2007 to address the above mentioned point. Although its feasibility and utilization were attractive, some reports revealed its drawbacks and limitations. The present report is to demonstrate short-term outcomes and information that might be useful for avoidance of potential complications from application of this device. MATERIAL AND METHOD: Three involved-feet in 2 patients with recalcitrant conditions and progressive hallux valgus, with at least a 6-month course of conservative treatment, were included. Limitation criteria for using 'Mini TightRope' were; non-athletic demand, good bone-stock, moderate severity of their hallux valgus (hallux-valgus-angle (HVA): 30-40, intermetatarsal-angle (IMA): 14-20), no hypermobility of first tarsometatarsal joint, and no signs of degenerative joint disease of first metatarsophalangeal/tarsometatarsal joint. Baseline data, American-Orthopaedic-Foot-and-Ankle-Society (AOFAS) scores, Visual-Analogue-Scale Foot-and-Ankle (VAS-FA) scores (including radiographic parameters) were collected at pre- and post-operative periods. The operations were carried out by a single surgeon. Precision in the creation of the interosseous-tunnel between 1st-2nd metatarsals was critical for this device. All patients strictly followed a similar postoperative-protocol, with austere prohibition of premature weight-bearing at forefoot-and-midfoot areas in 1-month postoperative-period. RESULTS: Although pre-postoperative (6-month) AOFAS/VAS-FA scores and radiographic angular differences were nonsignificant as to p-value: 0.10, there were satisfactory improvements of all scores and angular values in all postoperative periods. Patient number-two reported some tightness at 1st-2nd intermetatarsal area on left-foot. This was controlled with oral-medications in 1-month postoperative-period. Besides, there were no significant complications in the present report. CONCLUSION: 'Mini TightRope' might be of merit in hallux valgus correction for well-selected patients provided that technical implementation is precise and postoperative-protocol is followed with proper discipline.
OBJECTIVE: Bony works seems to be base procedure for hallux valgus correction. Due to the challenge and possible complications of these procedures, these issues generate 'Foot and Ankle Society' to consider alternative procedures. The 'Mini TightRope' (Arthrex, Inc., Naples, FL) or interrosseous suture/button device was introduced in 2007 to address the above mentioned point. Although its feasibility and utilization were attractive, some reports revealed its drawbacks and limitations. The present report is to demonstrate short-term outcomes and information that might be useful for avoidance of potential complications from application of this device. MATERIAL AND METHOD: Three involved-feet in 2 patients with recalcitrant conditions and progressive hallux valgus, with at least a 6-month course of conservative treatment, were included. Limitation criteria for using 'Mini TightRope' were; non-athletic demand, good bone-stock, moderate severity of their hallux valgus (hallux-valgus-angle (HVA): 30-40, intermetatarsal-angle (IMA): 14-20), no hypermobility of first tarsometatarsal joint, and no signs of degenerative joint disease of first metatarsophalangeal/tarsometatarsal joint. Baseline data, American-Orthopaedic-Foot-and-Ankle-Society (AOFAS) scores, Visual-Analogue-Scale Foot-and-Ankle (VAS-FA) scores (including radiographic parameters) were collected at pre- and post-operative periods. The operations were carried out by a single surgeon. Precision in the creation of the interosseous-tunnel between 1st-2nd metatarsals was critical for this device. All patients strictly followed a similar postoperative-protocol, with austere prohibition of premature weight-bearing at forefoot-and-midfoot areas in 1-month postoperative-period. RESULTS: Although pre-postoperative (6-month) AOFAS/VAS-FA scores and radiographic angular differences were nonsignificant as to p-value: 0.10, there were satisfactory improvements of all scores and angular values in all postoperative periods. Patient number-two reported some tightness at 1st-2nd intermetatarsal area on left-foot. This was controlled with oral-medications in 1-month postoperative-period. Besides, there were no significant complications in the present report. CONCLUSION: 'Mini TightRope' might be of merit in hallux valgus correction for well-selected patients provided that technical implementation is precise and postoperative-protocol is followed with proper discipline.