WAGNER HITSCHFELD, PABLO
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WAGNER HITSCHFELD, PABLO
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pwagner@udd.cl
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57194498847

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Is the Rotational Deformity Important in Our Decision-Making Process for Correction of Hallux Valgus Deformity?

2018 , Pablo Wagner , EMILIO WAGNER HITSCHFFELD

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Biomechanical Cadaveric Evaluation of the Role of Medial Column Instability in Hallux Valgus Deformity

2022 , WAGNER, EMILIO , WAGNER HITSCHFELD, PABLO , Florencia Pacheco , Mario López , Felipe Palma , Rodrigo Guzmán-Venegas , Francisco Jose Berral-de la Rosa

Background: Medial column instability is a frequent finding in patients with flatfeet and hallux valgus, within others. The etiology of hallux valgus is multifactorial, and medial ray axial rotation has been mentioned as having an individual role. Our objective was to design a novel cadaveric foot model where we could re-create through progressive medial column ligament damage some components of a hallux valgus deformity. Methods: Ten fresh-frozen lower leg specimens were used, and fluorescent markers were attached in a multisegment foot model. Constant axial load and cyclic tibial rotation (to simulate foot pronation) were applied, including pull on the flexor hallucis longus tendon (FHL). We first damaged the intercuneiform (C1-C2) ligaments, second the naviculocuneiform (NC) ligaments, and third the first tarsometatarsal ligaments, leaving the plantar ligaments unharmed. Bony axial and coronal alignment was measured after each ligament damage. Statistical analysis was performed. Results: A significant increase in pronation of multiple segments was observed after sectioning the NC ligaments. Damaging the tarsometatarsal ligament generated small supination and varus changes mainly in the medial ray. No significant change was observed in axial or frontal plane alignment after damaging the C1-C2 ligaments. The FHL pull exerted a small valgus change in segments of the first ray. Discussion: In this biomechanical cadaveric model, the naviculocuneiform joint was the most important one responsible for pronation of the medial column. Bone pronation occurs along the whole medial column, not isolated to a certain joint. Flexor hallucis longus pull appears to play some role in frontal plane alignment, but not in bone rotation. This model will be of great help to further study medial column instability as one of the factors influencing medial column pronation and its relevance in pathologies like hallux valgus. Clinical Relevance: This cadaveric model suggests a possible influence of medial column instability in first metatarsal pronation. With a thorough understanding of a condition’s origin, better treatment strategies can be developed.

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Publication

Preface

2022 , WAGNER HITSCHFFELD, EMILIO , WAGNER HITSCHFELD, PABLO

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Publication

PRECICE (R) magnetically-driven, telescopic, intramedullary lengthening nail: pre-clinical testing and first 30 patients

2017 , Pablo Wagner , Rolf D. Burghardt , Stuart A. Green , Stacy C. Specht , Shawn C. Standard , John E. Herzenberg

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Lesser Metatarsal Complications After MIS Surgery

2017 , Gabriel Khazen , Pablo Wagner , EMILIO WAGNER HITSCHFFELD

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Current Concepts in Treatment of Ligament Incompetence in the Acquired Flatfoot

2021 , WAGNER, EMILIO , WAGNER HITSCHFELD, PABLO

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Publication

Preface

2022 , WAGNER HITSCHFFELD, EMILIO , WAGNER HITSCHFELD, PABLO

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Republication of “Proximal Rotational Metatarsal Osteotomy for Hallux Valgus (PROMO): Short-term Prospective Case Series With a Novel Technique and Topic Review”

2023 , WAGNER HITSCHFELD, PABLO , WAGNER HITSCHFFELD, EMILIO

Background: Hallux valgus deformity consists of a lateral deviation of the great toe, metatarsus varus, and pronation of the first metatarsal. Most osteotomies only correct varus, but not the pronation of the metatarsal. Persistent postoperative pronation has been shown to increase deformity recurrence and have worse functional outcomes. The proximal rotational metatarsal osteotomy (PROMO) technique reliably corrects pronation and varus through a stable osteotomy, avoiding fusing any healthy joints. The objective of this research is to show a prospective series of the PROMO technique. Methods: Twenty-five patients (30 feet) were operated with the PROMO technique. The sample included 22 women and 3 men, average age 46 years (range 22-59), for a mean prospective follow-up of 1 year (range 9-14 months). Inclusion criteria included symptomatic hallux valgus deformities, absence of severe joint arthritis, or inflammatory arthropathies, with a metatarsal malrotation of 10 degrees or more, with no tarsometatarsal subluxation or arthritis on the anteroposterior or lateral foot radiograph views. The mean preoperative and postoperative Lower Extremity Functional Scale (LEFS) score, metatarsophalangeal angle, intermetatarsal angle, metatarsal malrotation, complications, satisfaction, and recurrence were recorded. Results: The mean preoperative and postoperative LEFS scores were 56 and 73. The median pre-/postoperative metatarsophalangeal angle was 32.5/4 degrees and the intermetatarsal angle 15.5/5 degrees. The metatarsal rotation was satisfactorily corrected in 24 of 25 patients. An Akin osteotomy was needed in 27 of 30 feet. All patients were satisfied with the surgery, and no recurrence or complications were found. Conclusions: PROMO is a reliable technique, with good short-term results in terms of angular correction, satisfaction, and recurrence. Long-term studies are needed to determine if a lower hallux recurrence rate occurs with the correction of metatarsal rotation in comparison with conventional osteotomies. Level of evidence: IV, prospective case series.

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Publication

The Use of a Triplanar Metatarsal Rotational Osteotomy to Correct Hallux Valgus Deformities

2019 , Pablo Wagner , EMILIO WAGNER HITSCHFFELD

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Publication

Hallux Valgus

2022 , WAGNER HITSCHFELD, PABLO , Emilio Wagner Hitschfeld

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