{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:18:11Z","timestamp":1787019491993,"version":"build-2736575974"},"reference-count":31,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2022,7,1]],"date-time":"2022-07-01T00:00:00Z","timestamp":1656633600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot &amp; Ankle Orthopaedics"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Metatarsal pronation has been claimed to be a risk factor for hallux valgus recurrence. A rounded shape of the lateral aspect of the first metatarsal head has been identified as a sign of persistent metatarsal pronation after hallux valgus correction. This study investigated the derotational effect of a reversed L-shaped (ReveL) osteotomy combined with a lateral release to correct metatarsal pronation. The primary hypothesis was that most cases showing a positive round sign are corrected by rebalancing the metatarsal-sesamoid complex. We further assumed that the inability to correct the round sign might be a risk factor for hallux valgus recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We retrospectively evaluated 266 cases treated with a ReveL osteotomy for hallux valgus deformity. The radiologic measurements were performed on weightbearing foot radiographs preoperatively, at an early follow-up (median, 6.2 weeks), and the most recent follow-up (median, 13 months). Univariate and multivariate logistic regression analyses identified risk factors for hallux valgus recurrence (hallux valgus angle [HVA] \u2265 20 degrees).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A preoperative positive radiographic round sign was present in 40.2% of the cases, of which 58.9% turned negative after the ReveL osteotomy ( P &lt; .001). Hallux valgus recurred in 8.6%. Risk factors for recurrence were a preoperative HVA &gt;30 degrees (odds ratio [OR] = 5.3, P &lt; .001), metatarsus adductus (OR = 4.0, P = .004), preoperative positive round sign (OR = 3.3, P = .02), postoperative HVA &gt;15 degrees (OR = 74.9; P &lt; .001), and postoperative positive round sign (OR = 5.3, P = .008). Cases with a positive round sign at the most recent follow-up had a significantly higher recurrence rate than those with a negative round sign (22.7% vs 5.9%, P &lt; .001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The ReveL osteotomy corrected a positive round sign in 58.9%, suggesting that not all hallux valgus deformities may need proximal derotation to negate the radiographic appearance of the round sign. A positive round sign was found to be an independent risk factor for hallux valgus recurrence. Further 3-dimensional analyses are necessary to better understand the effects and limitations of distal translational osteotomies to correct metatarsal pronation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>Level IV, case series.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/24730114221115697","type":"journal-article","created":{"date-parts":[[2022,8,6]],"date-time":"2022-08-06T00:50:06Z","timestamp":1659747006000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Effect of the Reversed L-Shaped Osteotomy on the Round Sign: Not All Hallux Valgus Deformities May Need Proximal Derotation to Correct the Radiographic Appearance of Metatarsal Pronation"],"prefix":"10.1177","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2747-2310","authenticated-orcid":false,"given":"Lizzy","family":"Weigelt","sequence":"first","affiliation":[{"name":"Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0092-0301","authenticated-orcid":false,"given":"Linda","family":"Wild","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2755-8576","authenticated-orcid":false,"given":"Elin","family":"Winkler","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Torrez","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thorsten","family":"Jentzsch","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan H.","family":"Wirth","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,8,5]]},"reference":[{"key":"bibr1-24730114221115697","doi-asserted-by":"publisher","DOI":"10.1177\/1071100714551022"},{"key":"bibr2-24730114221115697","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.N.00971"},{"key":"bibr3-24730114221115697","doi-asserted-by":"publisher","DOI":"10.1177\/107110070102200503"},{"key":"bibr4-24730114221115697","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2018.09.031"},{"key":"bibr5-24730114221115697","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2019.08.020"},{"key":"bibr6-24730114221115697","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2013.04.003"},{"key":"bibr7-24730114221115697","doi-asserted-by":"publisher","DOI":"10.1097\/01.btf.0000221101.31792.8b"},{"key":"bibr8-24730114221115697","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiomech.2010.05.002"},{"key":"bibr9-24730114221115697","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-010-0958-z"},{"key":"bibr10-24730114221115697","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.33B3.376"},{"key":"bibr11-24730114221115697","doi-asserted-by":"publisher","DOI":"10.1177\/1071100720937645"},{"key":"bibr12-24730114221115697","doi-asserted-by":"publisher","DOI":"10.1177\/1071100719855043"},{"key":"bibr13-24730114221115697","doi-asserted-by":"publisher","DOI":"10.1186\/1757-1146-3-2"},{"key":"bibr14-24730114221115697","doi-asserted-by":"publisher","DOI":"10.1177\/1071100715576994"},{"key":"bibr15-24730114221115697","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.16.00542"},{"key":"bibr16-24730114221115697","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2013.09.007"},{"key":"bibr17-24730114221115697","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199274010-00016"},{"key":"bibr18-24730114221115697","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-021-05136-9"},{"key":"bibr19-24730114221115697","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2012.05.005"},{"key":"bibr20-24730114221115697","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.H.00796"},{"key":"bibr21-24730114221115697","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.F.01455"},{"key":"bibr22-24730114221115697","doi-asserted-by":"publisher","DOI":"10.1007\/s00776-011-0136-1"},{"key":"bibr23-24730114221115697","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.16.00980"},{"key":"bibr24-24730114221115697","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2020.11.001"},{"key":"bibr25-24730114221115697","doi-asserted-by":"publisher","DOI":"10.1177\/1071100714548703"},{"key":"bibr26-24730114221115697","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2020.05.022"},{"key":"bibr27-24730114221115697","doi-asserted-by":"publisher","DOI":"10.1177\/1071100721997149"},{"key":"bibr28-24730114221115697","doi-asserted-by":"publisher","DOI":"10.1177\/107110078000100304"},{"key":"bibr29-24730114221115697","doi-asserted-by":"publisher","DOI":"10.1177\/2473011418790071"},{"key":"bibr30-24730114221115697","doi-asserted-by":"publisher","DOI":"10.1007\/s00776-015-0749-x"},{"key":"bibr31-24730114221115697","doi-asserted-by":"publisher","DOI":"10.1177\/1071100715572188"}],"container-title":["Foot 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