Use of Transcatheter Arterial Microembolization for the Treatment of Hallux Valgus – A Case Report

Background & Aims

Hallux valgus is a common disease resulting in chronic pain. Current treatment options
include wearing assistive devices and surgical correction, but these either have limited results or
require extensive post-operative rehabilitation . Transcatheter arterial microembolization works
by occluding blood vessels formed through abnormal angiogenesis, and therefore decreasing the
number of abnormal nerves associated with those vessels to alleviate pain. It has been shown to
provide analgesia in a wide variety of musculoskeletal conditions, including joint pain . This
report aims to describe treatment of chronic pain resulting from hallux valgus using transcatheter
arterial microembolization, which has not been documented before in the literature.

Methods

A 40-year-old male with a 2 to 3-year history of left hallux deformity and pain was diagnosed with moderate hallux valgus (39-degree angle). Consultation with an orthopedic surgeon recommended conservative treatment, but due to persistent intense pain, Transarterial Micro-Embolization (TAME) was suggested based on MRI findings. Scar tissue at the anterior tibial artery (ATA) led to a posterior tibial artery (PTA) puncture. Successful PTA puncture, catheterization, and embolization using mixed Imipenem reduced neovascularity around the 1st MTP joint, confirmed by pre and post-embolization angiograms. No post-procedural ischemia or cyanosis was observed during a 30-minute observation, allowing patient discharge. Post-operatively, the Visual Analog Scale (VAS) pain score decreased from 8 to 5, with sustained improvement at follow-ups (VAS 3, 2, and 2 at two weeks, one month, and two months, respectively).

Results

No post-procedural ischemia or cyanosis was observed during a 30-minute observation, allowing patient discharge. Post-operatively, the Visual Analog Scale (VAS) pain score decreased from 8 to 5, with sustained improvement at follow-ups (VAS 3, 2, and 2 at two weeks, one month, and two months, respectively).

Conclusions

Current analgesia options for hallux valgus are often insufficient and have side effects.
Utilization of TAME in a patient with moderate hallux valgus achieved satisfactory results, along
with minimal to no side effects. Due to the double vascular supply of the foot and the extensive
anastomoses of vasculature, risk of post-embolization ischemia is low. Therefore, TAME provides
to be a minimally-invasive technique with limited complications that provides moderate to long
term analgesia for hallux valgus.

References

1. The Treatment of Hallux Valgus. Dtsch Arztebl Int. 2012 Dec; 109(49): 857–868.
2. Rehabilitation After Hallux Valgus Surgery: Importance of Physical Therapy to Restore
Weight Bearing of the First Ray During the Stance Phase. Physical Therapy, Volume 89, Issue 9,
1 September 2009, Pages 934–945,
3. Transcatheter Arterial Embolization for Alleviating Chronic Musculoskeletal Pain and
Improving Physical Function: A Narrative Review. Diagnostics (Basel) 2022 Dec 30;13(1):134.
4. Transarterial Embolization for the Treatment of Chronic Musculoskeletal Pain: A Systematic
Review of Indications, Safety, and Efficacy. ACR Open Rheumatol 2022 Mar;4(3):209-217.
5. A Rat Model of Frozen Shoulder Demonstrating the Effect of Transcatheter Arterial
Embolization on Angiography, Histopathology, and Physical Activity. J Vasc Interv Radiol
2021 Mar;32(3):376-383
6. Injection Techniques for Common Chronic Pain Conditions of the Foot: A Comprehensive
Review Pain and Therapy volume 9, pages145–160 (2020)
7.PROSPECT guideline for hallux valgus repair surgery: a systematic review and
procedure?specific postoperative pain management recommendations. Reg Anesth Pain Med
2020;45:702–708
8. Location and direction of the nutrient artery to the first metatarsal at risk in osteotomy for
hallux valgus. Foot Ankle Surg 2018 Oct;24(5):460-465
9. Intra-Arterial Infusion of Imipenem/Cilastatin Sodium through a Needle Inserted into the
Radial Artery as a New Treatment for Refractory Trapeziometacarpal Osteoarthritis. J Vasc
Interv Radiol 2021 Sep;32(9):1341-1347
10. Embolic Characteristics of Imipenem-Cilastatin Particles in Vitro and in Vivo: Implications
for Transarterial Embolization in Joint Arthropathies. J Vasc Interv Radiol 2021 Jul;32(7):1031-
1039

Presenting Author

Yu-Han Huang

Poster Authors

Yu Han Huang

Shin Kong Wu Ho-Su Memorial Hospital/Taipei

Lead Author

E-mail

Topics

Treatment/Management: Interventional Therapies – Other