title: Increased Incidence and Severity of Postoperative Radiographic Hallux Valgus Interphalangeus With Surgical Correction of Hallux Valgus.
abstract: BACKGROUND
  A previous study has shown an increased radiographic prevalence and severity of hallux valgus interphalangeus (HVIP) after surgical correction of hallux valgus (HV) due to correction of pronation deformity. The purpose of this study was to evaluate the change in pre- and postoperative HVIP deformity with correction of HV with multiple radiographic parameters.
  
  
  METHODS
  A retrospective chart review identified all bunion surgeries performed at a single center from July 1, 2009, to September 30, 2012. Exclusion criteria included prior bony surgery to the first ray, inadequate films, nonadult bunion, Akin osteotomy, or surgical treatment other than bunion correction. Pre- and postoperative films were reviewed for 2 HV angular measurements and 5 HVIP measurements, which were compared. The angles measured were hallux valgus angle (HVA), first intermetatarsal angle (IMA), hallux interphalangeus angle (HIA), distal metatarsal articular angle (DMAA), proximal phalangeal articular angle (PPAA), proximal to distal phalangeal articular angle (PDPAA), and total distal deformity (TDD). Prevalence of HVIP was analyzed in pre- and postoperative radiographs. A 1-sided Student t test was used to compare continuous data, and a chi-square test was used to compare categorical data. Ninety-two feet in 82 patients were eligible.
  
  
  RESULTS
  The average preoperative HV improved with surgery. Preoperative HVA improved from 27 to 11 degrees (P < .001). Preoperative IMA improved from 13.6 to 6.1 degrees (P < .001). HVIP worsened after surgery. Preoperative HIA increased from 7.2 to 13.2 degrees (P < .001). DMAA worsened from 7.3 to 9.2 degrees (P = .001). PPAA worsened from 3.2 to 6.2 degrees. PDPAA worsened from 6.7 to 8.2 degrees (P < .001). The TDD increased from 14.6 to 17.9 degrees (P < .001). The prevalence of HVIP pre- and postoperatively as defined by HIA increased from 26% to 79% (P < .001) and by PPAA from 12% to 46% (P < .001).
  
  
  CONCLUSIONS
  Initial assessment of preoperative radiographs underestimated HVIP. Postoperative correction of the deformity revealed HVIP that was not obvious preoperatively.
  
  
  METHODS
  Level III, retrospective comparative series.
authors: Department of Orthopaedic Surgery, University of Southern California-Keck School of Medicine, Los Angeles, CA, USA alexis.dixon@usc.edu.
authors: Alexis E
authors: AE
authors: Dixon
authors: Department of Orthopaedic Surgery, University of Southern California-Keck School of Medicine, Los Angeles, CA, USA.
authors: Lydia C
authors: LC
authors: Lee
authors: Division of Orthopedics, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors: Timothy P
authors: TP
authors: Charlton
authors: Division of Orthopedics, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors: David B
authors: DB
authors: Thordarson
mesh_terms: D006215:Hallux Valgus / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008682:Metatarsal Bones / Q000000981:diagnostic imaging*; D010027:Osteotomy / Q000379:methods; D011183:Postoperative Complications; D057234:Preoperative Period; D011859:Radiography; D012189:Retrospective Studies; D050277:Toe Phalanges / Q000000981:diagnostic imaging*
keywords: forefoot disorder; hallux disorders