Hallux Interphalangeal Angle Research Articles

Relationship Between Hallux Valgus Interphalangeal Deformity and the Recurrence of Ingrown Toenail in Children.

An abnormal hallux interphalangeal angle may be an important risk factor for the recurrence of ingrown toenails. Sixty pediatric patients who underwent surgery for an ingrown toenail were evaluated retrospectively in terms of recurrence. The patients were divided into two groups. Group 1 included 30 patients (22 boys and eight girls) with hallux valgus interphalangeal deformity. Group 2 included 30 patients (20 boys and ten girls) without toe deformity. The mean ± SD patient age was 12.8 ± 1.42 years and 12.5 ± 1.45 years in groups 1 and 2, respectively. There was no significant difference between the patient and control groups in terms of age and sex (P > .05). The mean ± SD follow-up time was 30.2 ± 13.46 months in group 1 and 31.3 ± 12.86 months in group 2 (P = .286). We observed recurrence in six patients (20%) in group 1 and in two patients (6.7%) in group 2. The recurrence of an ingrown toenail may be associated with an increased hallux interphalangeal angle in pediatric patients. Factors related to the hallux interphalangeal angle abnormality, which increases the risk of ingrown toenails, also increase the recurrence rate in these patients. Therefore, it is surmised that hallux valgus interphalangeal deformity should be evaluated before surgery, and patients and their families should be informed about the increased risk of recurrence.

Hallux Valgus Interphalangeus Measurement: Comparison of the Two Radiographic Methods

Category: Midfoot/Forefoot Introduction/Purpose: To determine the reliability of Delta PP (difference in medial and lateral proximal phalanx wall length) compared to HIA (hallux interphalangeal angle) in the assessment of HVI (hallux valgus interphalangeus) in both pre and postoperative radiographs. Methods: This was a retrospective observational study of 186 feet with hallux valgus. The number of cases required to adequately power the study was 128. Preoperative and postoperative hallux alignment were evaluated by two different radiological parameters, Delta PP and HIA. Inter-observer variability was assessed independently by two authors and compared using a intraclass correlation coefficient. Results: The intra-class correlation coefficient was more than 0.8 for all parameters, thus both HIA and Delta PP measurement provide reliable and reproducible data. Mean HIA significantly increased following surgical correction of hallux valgus. In comparison, the mean Delta PP decreased after correction. This postoperative increase in HIA indicates that pre-operative HIA underestimates the magnitude of HVI and therefore is an inaccurate tool for measuring HVI's contribution to the TVDH (total valgus deformity of the hallux) and to preoperative planning. However, the Delta PP was a greater determinant of the phalanx deformity's contribution to the TVDH. Conclusion: The outcome of our study shows that both HIA and Delta PP are reproducible when assessing the hallux valgus interphalangeus deformity, however, Delta PP quantifies the amount of correction obtained more precisely. The additional benefit of measuring the Delta PP is that it allows for accurate planning in determining the dimensions of the medial based wedge of the Akin osteotomy that needs to be resected.

The Use of Advanced Semi-Automated Bone Segmentation in Hallux Rigidus

Category: Midfoot/Forefoot Introduction/Purpose: Weight-Bearing Computed Tomography (WBCT) measurements represent a reliable tool for radiographic analysis of the first ray, including multiplanar assessment in the axial, sagittal, and coronal planes. WBCT can allow for more reliable studies of pathologies, such as Hallux Rigidus (HR), which permits several anatomical points to be evaluated for a correct clinical-radiographic diagnosis. In addition, new software with an advanced semi-automated segmentation system obtains semi-automatic 3D measurements of WBCT scan data sets, minimizing the errors in reading angular measurements. The study`s objective was (1) to assess the reliability of WBCT computer-assisted semi-automatic imaging measurements in HR, (2) to compare semi-automatic to manual measurements in the setting of HR, and (3) to compare semi-automatic measurements between a pathologic (HR) group and a control standard group. Methods: This was a retrospective, IRB approved study of patients with Hallux Rigidus deformity. The sample size calculation was based on the Metatarsus Primus Elevatus (MPE). A control group consisting of 20 feet without HR and a pathologic group consisting of 20 feet with HR was necessary for this study. All WBCT manual and semiautomatic 3D measurements were performed using the following parameters: (1) first Metatarsal-Proximal Phalanx Angle (1stMPP) (sagittal plane), (2) Hallux Valgus Angle (HVA), (3) first to second Intermetatarsal Angle (IMA), (4) Hallux Interphalangeal Angle (IPA), (5) first Metatarsal Lengths (1stML), (6) second Metatarsal Length (2ndML), (7) first Metatarsal Declination Angle (1stMD), (8) second Metatarsal Declination Angles (2ndMD), and (9) MPE. The semiautomatic 3D measurements were performed using the Bonelogic Software. The differences between pathologic and control cases were assessed with a Wilcoxon test and P<= 0.05 was considered significant. Results: Interobserver and intraobserver agreement and consistency for manual versus semi-automatic WBCT measurements assessed by ICC demonstrated excellent reliability. Manual and semi-automatic measurements were performed in individuals with HR. According to the Pearson's coefficient, there was a strong positive linear correlation between both methods for the following parameters evaluated: HVA, (ρ = 0.96); IMA, (ρ = 0.86); IPA, (ρ = 0.89); 1stML, (ρ = 0.96); 2ndML, (ρ = 0.91); 1stMD, (ρ = 0.86); 2ndMD, (ρ = 0.95) and, MPE, (ρ = 0.87). Agreement between the manual and semi-automatic methods was tested using a Bland- Altman plot and expressed excellent agreement between the methods. Comparison between the pathological group with HR and the control (standard) group allowed for the differentiating of the pathological (HR) from the non-pathological conditions for MPE (p < 0.05). Conclusion: Semiautomatic measurements are reproducible and comparable to measurements performed manually, showing excellent interobserver and intraobserver agreement and consistency. The software used differentiated pathological from non- pathological conditions only when submitted to semi-automatic MPE measurements. The development of advanced semi-automatic segmentation software with minimal user intervention is an essential step toward the establishment of big data and can be integrated into clinical practice, facilitating decision making.

The Use of Advanced Semiautomated Bone Segmentation in Hallux Rigidus.

Weightbearing computed tomography (WBCT) measurements allow evaluation of several anatomical points for a correct clinical-radiographic diagnosis of pathologies, such as hallux rigidus (HR). In addition, a new semiautomatic segmentation software obtains automated 3D measurements from WBCT scan data sets, minimizing errors in reading angular measurements. The study's objective was (1) to evaluate the reliability of WBCT semiautomatic imaging measures in HR, (2) to evaluate correlation and agreement between manual and semiautomatic measures in the setting of HR, and (3) to compare semiautomatic measurements between pathologic (HR) and standard control groups. A retrospective study of HR patients was performed including 20 feet with HR. WBCT manual and semiautomatic 3D measurements were performed using the following parameters: (1) first metatarsal-proximal phalanx angle (1stMPP), (2) hallux valgus angle (HVA), (3) first to second intermetatarsal angle (IMA), (4) hallux interphalangeal angle (IPA), (5) first metatarsal length (1stML), (6) second metatarsal length (2ndML), (7) first metatarsal declination angle (1stMD), (8) second metatarsal declination angles (2ndMD), and (9) metatarsus primus elevatus (MPE). The differences between pathologic and control cases were assessed with a Wilcoxon test. Interobserver and intraobserver agreement for manual vs semiautomatic WBCT measurements demonstrated excellent reliability. According to the Pearson coefficient, there was a strong positive linear correlation between both methods for the following parameters evaluated: HVA (ρ = 0.96), IMA (ρ = 0.86), IPA (ρ = 0.89), 1stML (ρ = 0.96), 2ndML (ρ = 0.91), 1stMD (ρ = 0.86), 2ndMD (ρ = 0.95), and MPE (ρ = 0.87). Comparison between the pathologic group with HR and the control (standard) group allowed for the differentiating of the pathologic (HR) from the non-pathologic conditions for MPE (p < 0.05). Semiautomatic measurements are reproducible and comparable to measurements performed manually, showing excellent interobserver and intraobserver agreement. The software used differentiated pathologic from nonpathologic conditions when submitted to semiautomatic MPE measurements. Level III, retrospective comparative study.

Evaluation of the relationship between hallux valgus and foot measurements in radiographic images of adult female.

In the present study, we aimed to determine the relationship of HV angle with angles and measurements obtained from lateral and anteroposterior (AP) radiological images of the foot in individuals with HV. The present study had a retrospective design, and the participants consisted of 66 female patients between the ages of 19 and 64 who applied to Orthopedics and Traumatology and were diagnosed with Hallux valgus. Metatarsus adductus angle, metatarsus primus adductus angle, hallux valgus angle, hallux interphalangeal angle, metatarsal break angle, first metatarsal protrusion distance, metatarsal width, talocalcaneal angle, AP Meary's angle were measured on AP view and calcaneal inclination angle, talar declination angle, lateral talocalcaneal angle, first metatarsal declination angle, fifth metatarsal declination angle, navicular height, lateral Meary's angle, tibiotalar angle were measured on a lateral radiograph. The IBM SPSS 21.0. program was used for statistical analysis, and the level of significance was taken as p < 0.05. There were statistically significant differences between the right and left feet in MPA and AMA measurements. The results showed that HV angle (HVA) had a weak relationship with MAA and MW, as well as a moderately positive relationship with MPA. However, it had a moderately negative relationship with AMA and a weak negative relationship with HIPA. We believe that in addition to the HVA angle, MPA and AMA angles should be considered in the diagnosis of HV, especially as the HVA angle is moderately positively correlated with the MPA angle and moderately negatively correlated with the AMA angle.

Reliability of intraoperative radiographic visual assessment of the hallux interphalangeal angle after hallux valgus correction

Objective: The aim of this study was to evaluate the reliability and reproducibility of visual estimation of the hallux interphalangeal angle (IPA). As a secondary aim we assessed for change in the IPA before and after hallux valgus (HV) correction. Methods: A total of 50 surgically treated HV deformities were included in the study. Two surgeons visually estimated the IPA on intraoperative fluoroscopy after correcting HV. The fellow then measured the IPA formally on a printout of the fluoroscopic image. Pre-and intraoperative HVI angles were compared to assess for change after HV correction. Results: The researchers found the interobserver reliability of radiographic visual assessment of the IPA to be 78% and intraobserver reliability to be 76% and 80% for surgeon 1 and 2, respectively. It was found that the preoperative IPA is on average 5.5 degrees less than IPA after HV correction. Conclusion: Radiographic visual assessment of the IPA of the hallux was found to be reliable intraoperatively, thus aiding in the amount of correction required by Akin osteotomy. HVI can be masked by hallux pronation in HV deformity and should be assessed intraoperatively after HV correction. Level of Evidence II; Therapeutic Studies; Prospective Comparative Study.

Hallux Valgus Interphalangeus Measurement: Comparison of the 2 Radiographic Methods.

To determine the reliability of Delta PP (difference in medial and lateral proximal phalanx wall length) compared with HIA (hallux interphalangeal angle) in the assessment of HVI (hallux valgus interphalangeus) in both preoperative and postoperative radiographs. This was a retrospective observational study of 186 feet with hallux valgus. The number of cases required to adequately power the study was 128. Preoperative and postoperative hallux alignment were evaluated by 2 different radiological parameters, Delta PP and HIA. Interobserver variability was assessed independently by 2 authors and compared using a intraclass correlation coefficient. The intraclass correlation coefficient was more than 0.8 for all parameters, thus both HIA and Delta PP measurement provide reliable and reproducible data. Mean HIA significantly increased following surgical correction of hallux valgus. In comparison, the mean Delta PP decreased after correction. This postoperative increase in HIA indicates that preoperative HIA underestimates the magnitude of HVI and therefore is an inaccurate tool for measuring HVI's contribution to the TVDH (total valgus deformity of the hallux) and to preoperative planning. However, the Delta PP was a greater determinant of the phalanx deformity's contribution to the TVDH. The outcome of our study shows that both HIA and Delta PP are reproducible when assessing the HVI deformity; however, Delta PP quantifies the amount of correction obtained more precisely. The additional benefit of measuring the Delta PP is that it allows for accurate planning in determining the dimensions of the medial-based wedge of the Akin osteotomy that needs to be resected. Level 4.

Comparative Assessment of Hallux Rigidus using Conventional Radiograph and Weightbearing CT

Category:Midfoot/ForefootIntroduction/Purpose:The etiology of hallux rigidus (HR) is not well understood and Its association with first-ray hypermobility, hallux valgus and metatarsus primus elevatus (MPE) has not been clearly proven. MPE, elevated first metatarsal has been a topic of debate since Lambrinudi`s first description. Recent studies have supported MPE in hallux rigidus by measuring with various methods on wightbearing lateral radiographs, but there are limitations of conventional radiography due to variation in X- ray projection and superimposed metatarsals regardless of the methods of measurement. Our objective was to assess MPE and other associated parameters with hallux rigidus via radiography and WBCT for convergent validity and to evaluate the use of classification system used in conventional radiography with WBCT.Methods:This is a single-center, retrospective study from prospectively collected data. 20 symptomatic hallux rigidus patient with weightbearing radiograph and WBCT were enrolled from October 2014 to December 2020. Measured parameters included hallux valgus angle (HVA), intermetatarsal angle (IMA), hallux interphalangeal angle (HIPA), distal metatarsal articular angle (DMAA), 1st TMT joint version, First and second metatarsal lengths, Metatarsus adductus angle, 2nd cuneiform-2nd metatarsal angle, Talus-1st Metatarsal Angel, First and second metatarsal declination angles, and MPE. MPE was measured as the direct distance between 1st and 2nd metatarsals (modified Horton index). All patients were graded according to the radiographic criteria of Coughlin and Shurnas classification on radiographs and WBCT, separately. Paired T-test was performed to compare radiographic measurements with WBCT.Results:Mean age was 55.9, 12 males and 8 females. HVA (15.73 in X-ray vs 14.04 in WBCT), AP first TMT version (16.25 vs 16.47), 2nd cuneiform-2nd metatarsal angle (24.54 vs 26.60), Talus-1st Metatarsal Angel (-7.67 vs -7.89) were not different between radiograph and WBCT. MPE was measured higher in WBCT by 0.86 mm compared to radiograph. First metatarsal declination angle was lower in WBCT by 2.9° indicating increased MPE. When graded with radiographic findings, 5 (25%) patients were grade 1, 5 (25%) patients were grade 2 and 10 (50%) grade 3, when graded with WBCT, 1 (5%) patient had grade 1, 3 (15%) patients were grade 2 and 16 (80%) grade 3. Dorsal subluxation/translation of first metatarsal at first TMT joint was observed 3 (15%) in radiograph and 9 (45%) in WBCT.Conclusion:HVA, AP first TMT version, 2nd cuneiform-2nd metatarsal angle, Talus-1st Metatarsal Angel demonstrated consistent measurements in radiograph and WBCT. MPE was measured higher in WBCT when measured with direct distance (0.86 mm) between the first and second metatarsals using modified Horton index and first metatarsal declination angle (2.9°). When graded with WBCT, the subchondral cyst in the proximal phalanx and metatarsal head were better delineated leading to higher grade in WBCT. Further studies are needed for inter-rater reliability and discriminant validity of the measurements determined by differences between different groups (HR vs control).

Feasibility study of hallux valgus measurement with a deep convolutional neural network based on landmark detection.

To develop a deep learning algorithm based on automatic detection of landmarks that can be used to automatically calculate forefoot imaging parameters from radiographs and test its performance. A total of 1023 weight-bearing dorsoplantar (DP) radiographs were included. A total of 776 radiographs were used for training and verification of the model, and 247 radiographs were used for testing the performance of the model. The radiologists manually marked 18 landmarks on each image. By training our model to automatically label these landmarks, 4 imaging parameters commonly used for the diagnosis of hallux valgus could be measured, including the first-second intermetatarsal angle (IMA), hallux valgus angle (HVA), hallux interphalangeal angle (HIA), and distal metatarsal articular angle (DMAA). The reference standard was determined by the radiologists' measurements. The percentage of correct key points (PCK), intragroup correlation coefficient (ICC), Pearson correlation coefficient (r), root mean square error (RMSE), and mean absolute error (MAE) between the predicted value of the model and the reference standard were calculated. The Bland-Altman plot shows the mean difference and 95% LoA. The PCK was 84-99% at the 3-mm threshold. The correlation between the observed and predicted values of the four angles was high (ICC: 0.89-0.96, r: 0.81-0.97, RMSE: 3.76-6.77, MAE: 3.22-5.52). However, there was a systematic error between the model predicted value and the reference standard (the mean difference ranged from - 3.00 to - 5.08°, and the standard deviation ranged from 2.25 to 4.47°). Our model can accurately identify landmarks, but there is a certain amount of error in the angle measurement, which needs further improvement.

A comparison of the effectiveness of splinting, exercise and electrotherapy in women patients with hallux valgus: A randomized clinical trial

BackgroundHallux valgus (HV) is a very common foot deformity involving lateral deviation of the hallux and medial deviation of the first metatarsal head. ObjectivesTo investigate the effects of HV night splinting, exercise and electrotherapy on the HV angle, and foot-specific health-related quality of life. MethodsSixty women (120 feet) with bilateral HV deformity were randomly assigned to one of three groups — an HV night splint (SP) group, an exercise (EX) group, and a high-voltage galvanic stimulation (HVPGS) (EL) group. The patients in SP group used the HV night splints while resting or sleeping for at least 8 h a day and the patients in the EX group performed exercises 3–4 times a day with 10 repetitions for the duration of the one-month treatment period. Twenty-minute HVPGS was applied in total over three weekly sessions for four weeks in EL group. Angular degrees (hallux interphalangeal angle (HIPA), HV angle (HVA), and intermetatarsal angle (IMA)) were determined before (t0) and three months after treatment (t2). Foot-specific quality of life was assessed using the Manchester-Oxford Foot Questionnaire (MOFQ) at t0, after one month (t1), and at t2. ResultsAll groups exhibited significant changes in the HIPA, HVA, and IMA angles and outcome measures (p ≤ 0.001). Decreases in the HIPA and IMA angles, and MOFQ-Pain subscale scores, were higher in the SP group than in the other two groups (p < 0.05). IMA angle at t2, MOFQ-Walking score at t1 and t2 and MOFQ-Pain subscale score at t1 were lower in the SP group (p < 0.05). ConclusionThe SP group exhibited more positive effects in the parameters measured than the other two groups. A combination of these conservative treatment approaches may be more beneficial to improve HV symptoms with longer follow-up periods. ClinicalTrials.gov IdentifierNCT04393545.

Extended Distal Chevron Osteotomy and Akin Osteotomy Using Bioabsorbable Materials for Treatment of Moderate to Severe Hallux Valgus

The purpose of this study was to investigate the suitability of bioabsorbable materials for fixation of extended distal chevron osteotomy and Akin osteotomy for the treatment of moderate to severe hallux valgus. We performed a retrospective analysis of extended distal chevron osteotomy and Akin osteotomy for the treatment of moderate to severe hallux valgus (33 patients, 42 feet). Fixation of extended distal chevron osteotomy and Akin osteotomy was performed using poly-l-lactic acid pins and polylactic acid/polyglycolic acid copolymer sutures, respectively. The radiological outcomes were evaluated based on the preoperative and 3-year follow-up intermetatarsal angle, hallux valgus angle, and hallux interphalangeal angle. The clinical results were assessed according to 3-year follow-up Manchester-Oxford Foot Questionnaire scores, patient satisfaction, and postoperative complications. All radiological and clinical results were compared with those of a control group treated with metallic implants. The mean 3-year follow-up intermetatarsal angle, hallux valgus angle, and hallux interphalangeal angle were significantly corrected from the preoperative values (all p < .001). The mean 3-year follow-up Manchester-Oxford Foot Questionnaire scores score was significantly improved from the preoperative values (p < .001). Regarding patient satisfaction, 88.1% of the patients reported good to excellent results. A total of seven complications were reported. All radiological and clinical results were comparable with those of control group treated with metallic implant. Based on these results, we recommend using bioabsorbable materials as another reliable device for fixation of extended distal chevron osteotomy and Akin osteotomy even for the treatment of moderate to severe hallux valgus.

The association between foot alignment and the development of ingrown toenails: A case-control study in a young adult military population

BackgroundThis case-control study aimed to explore an association between foot alignment and development and presentation of the ingrown toenail. MethodsRadiographs were evaluated for hallux interphalangeal angle (HIA), hallux valgus angle (HVA), talonavicular coverage angle (TNC), talo-first metatarsal (Meary’s) angle, and calcaneal pitch angle (CP), as well as medial sesamoid position in a cohort of 103 young and healthy patients (mean age of 20.5 years) with ingrown toenails. A control group of 63 patients was included, and the radiographic parameters were compared. Subgroup analysis was performed in patients with lateral (n = 65) or medial (n = 38) nail fold involvement. ResultsThe overall study group demonstrated a larger TNC and Meary’s angle and smaller CP than the control group, while no significant difference was found regarding the HIA and HVA. The lateral nail fold group had a larger HIA when compared to the medial nail fold group. Multiple regression analysis revealed that for ingrown toenail development, the only risk factor was a decrease in the CP. In the case of lateral nail fold involvement, an increase in the HIA found to be the only factor. ConclusionA lower medial longitudinal arch seems to be a predisposing factor in developing an ingrown toenail. The lateral nail fold involvement was associated with lateral deviation of the distal phalanx. The result of this study could provide information on prevention, treatment, recurrence, and patient counseling of an ingrown toenail in otherwise young and healthy individuals.

Reliability of the Radiographic Measurement of the Hallux Interphalangeal Angle.

The hallux valgus interphalangeus (HVI) deformity has a common association with hallux valgus and hallux rigidus. The HVI is formed by the angle between the long axes of the proximal and distal phalanges. The normal value for this angular deformity in the coronal plane is less than 10°. The aim of this study was to analyze the intra- and inter-observer reliability of measuring the interphalangeal angle by orthopaedic surgeons. This study is the first study to evaluate specifically the reliability and reproducibility of measuring the HVI angle. Twenty-one X-ray prints of weightbearing feet constituted a set. Sixteen qualified orthopaedic surgeons were asked to measure the HVI angle of all 21 X-ray images in the set. Three randomized sets were sent to each evaluator at 4-week intervals. After all 3 sets were measured, data were retrieved and statistically analyzed to determine the inter- and intraobserver variability and reliability in the measurement of the HVI angle. Reproducibility of the HVI measurement was assessed using 3 categories, which included the ability to measure the same angle 3 times and achieve: 3° or less, 5° or less, and more than 5° variation. The intraobserver reliability was found to be 5° or less in 85.2% of participants and the interobserver reliability was 81.2%. The researcher did not find significant correlation between the surgeons' level of experience with regard to the reliability of measuring the HVI angle. The inter- and intraobserver reliabilities of measuring the HVI angle is 81.2% and 85.2%, respectively. The level of experience of the surgeon does not improve this reliability. Level II.

Evaluation of the relationship between ingrown toenail and hallux interphalangeal angle

Evaluation of the relationship between ingrown toenail and hallux interphalangeal angle

Foot and Ankle Radiographic Parameters in Korean Adults Vary by Sex and Age

Although many radiographic measurements of the foot and ankle have been used, reference values for normal functional groups are rarely reported. These can change according to sex and age; therefore, this study aimed to: (1) determine reference values for radiographic foot and ankle angles in an asymptomatic healthy Korean population, and (2) compare differences in the measurements according to sex and age. A total of 200 healthy volunteers were recruited, including 100 young adults (50 males, 50 females) aged 20 to 35 years, and 100 older adults (50 males, 50 females) aged 60 to 69 years. Weightbearing ankle anteroposterior views, talar tilt, and tibiotalar angles were measured. On the weightbearing foot anteroposterior views, the hallux valgus, hallux interphalangeal, and talo-first metatarsal angles were measured. On the weightbearing lateral foot views, the calcaneal pitch, lateral talo-calcaneal, lateral talo-first metatarsal, and lateral calcaneo-first metatarsal angles were measured. Values were stratified by sex and age, and statistically compared. The hallux valgus, calcaneal pitch, and lateral calcaneo-first metatarsal angles were affected by both sex and age; the hallux interphalangeal angle was affected by age and the lateral talo-first metatarsal angle by sex. We presented reference values for foot and ankle radiographic measurements in a healthy Korean population; several radiographic indices varied significantly by sex or age, which were grossly similar to previous studies based on white race. The study data can serve as a basis for evaluation of foot and ankle disorders.

P 094 – Sit-to-stand of rheumatoid arthritis post-menopausal women vs. healthy post-menopausal – Antero-posterior displacement of centre of gravity and centre of pressure

Although many radiographic measurements of the foot and ankle have been used, reference values for normal functional groups are rarely reported. These can change according to sex and age; therefore, this study aimed to: (1) determine reference values for radiographic foot and ankle angles in an asymptomatic healthy Korean population, and (2) compare differences in the measurements according to sex and age. A total of 200 healthy volunteers were recruited, including 100 young adults (50 males, 50 females) aged 20 to 35 years, and 100 older adults (50 males, 50 females) aged 60 to 69 years. Weightbearing ankle anteroposterior views, talar tilt, and tibiotalar angles were measured. On the weightbearing foot anteroposterior views, the hallux valgus, hallux interphalangeal, and talo-first metatarsal angles were measured. On the weightbearing lateral foot views, the calcaneal pitch, lateral talo-calcaneal, lateral talo-first metatarsal, and lateral calcaneo-first metatarsal angles were measured. Values were stratified by sex and age, and statistically compared. The hallux valgus, calcaneal pitch, and lateral calcaneo-first metatarsal angles were affected by both sex and age; the hallux interphalangeal angle was affected by age and the lateral talo-first metatarsal angle by sex. We presented reference values for foot and ankle radiographic measurements in a healthy Korean population; several radiographic indices varied significantly by sex or age, which were grossly similar to previous studies based on white race. The study data can serve as a basis for evaluation of foot and ankle disorders.

Natural Progression of Radiographic Indices in Juvenile Hallux Valgus Deformity

Category: Bunion Introduction/Purpose: There is a lack of quantitative studies on the progression of juvenile hallux valgus deformity. Therefore, we performed this study to estimate an annual change of radiographic indices for juvenile hallux valgus. Methods: We reviewed medical records of consecutive patients under the age of 15 with juvenile hallux valgus who underwent weight-bearing foot radiographs more than twice, and were followed over a period of one year or more. A total of 133 feet from 69 patients were included. Hallux valgus angle, hallux interphalangeal angle, intermetatarsal angle, metatarsus adductus angle, distal metatarsal articular angle, anteroposterior talo-1st metatarsal angle, anteroposterior talo-2nd metatarsal angle, and lateral talo-1st metatarsal angle were measured and were used as a study criteria. The progression rate of hallux valgus angle was adjusted by multiple factors including the use of a linear mixed model with gender and radiographic measurements as the fixed effects and laterality and each subject as the random effect. Results: Our results demonstrate that the value of hallux valgus angle on the radiographs progressed as the patients grew older. The hallux valgus angle increased by 0.8° per year (p&lt;0.001)(Figure). The distal metatarsal articular angle also increased by 0.8 per year (p=0.003). Conversely, hallux interphalangeal angle decreased by 0.2° per year (p=0.019). Progression of the intermetatarsal angle and metatarsus adductus angle with aging were not statistically significant. There was a difference in progression of radiographic indices between older patients (≥10 years) and younger patients (&lt;10 years). The hallux valgus angle increased by 1.5° per year (p&lt;0.001) in younger patients, progression of the hallux valgus angle in older patients was not statistically significant (p=0.869) as children grew up. Conclusion: These results suggest that the hallux valgus angle increased in patients with juvenile hallux valgus under 10 years old, unlike the patients aged 10 or older. We believed that our results can help surgeons to determine a treatment strategy that uses the growth potential to achieve correction of deformity such as lateral hemiepiphyseodesis of the 1st metatarsal to patients with juvenile hallux valgus.

Hallux valgus interphalangeus: reliability of radiological assessment

BackgroundReliable radiographic measurement of hallux valgus interphalangeus (HVI) deformity has a role in guiding surgical management. HVI can be assessed using:•Hallux interphalangeal angle (HIA).•Distal articular set angle (DASA).•Proximal to distal phalangeal articular angle (PDPA).The aim of the study is to investigate the reliability of these radiological parameters. MethodsSeventy foot radiographs in patients pre and post hallux valgus corrective surgery were assessed by 3 observers. HVI was assessed using the radiological measurements described above. Two-way random, single measure intra-class correlation coefficients were calculated to assess agreement. ResultsInter-observer reliability showed good agreement for DASA [ICC=0.77(0.61–0.88)], and excellent for HIA [ICC=0.92(0.85–0.96)] and PDPA [ICC=0.91(0.84–0.96)]. Intra-observer reliability was excellent for all angles; DASA [ICC=0.88 (0.76–0.95)], HIA [ICC=0.94(0.86–0.97)] and PDPA [ICC=0.83(0.65–0.92)]. ConclusionsReliability is good to excellent among these three radiological techniques for assessing HVI. The HIA and PDPA are slightly more reliable.

Natural progression of radiographic indices in juvenile hallux valgus deformity

BackgroundThis study aimed to estimate the annual change in radiographic indices for juvenile hallux valgus (JHV) and to analyze the factors that influence deformity progression. MethodsPatients aged <15 years who had JHV and were followed up for at least 1 year were included. Hallux valgus angle (HVA), hallux interphalangeal angle, intermetatarsal angle, metatarsus adductus angle, distal metatarsal articular angle, anteroposterior talo-first metatarsal angle, and lateral talo-first metatarsal angle were evaluated. The progression rate of HVA was adjusted by multiple factors by using a linear mixed model. ResultsA total of 133 feet were included. The HVA and distal metatarsal articular angle both increased by 0.8° per year (p<0.001 and p=0.003, respectively). HVA increased by 1.5° per year (p<0.001) at under the age of 10, and the HVA progression in the older patients was not statistically significant. ConclusionsJHV deformity could progress with aging. Most deformity progression could occur before the age of 10 years.

Radiographic Measurements Associated With the Natural Progression of the Hallux Valgus During at Least 2 Years of Follow-up.

This study aimed to investigate the radiographic measurements associated with the progression of hallux valgus during at least 2 years of follow-up. Seventy adult patients with hallux valgus who were followed for at least 2 years and underwent weightbearing foot radiography were included. Radiographic measurements included the hallux valgus angle (HVA), hallux interphalangeal angle, intermetatarsal angle (IMA), metatarsus adductus angle, distal metatarsal articular angle (DMAA), tibial sesamoid position, anteroposterior (AP) talo-first metatarsal angle, and lateral talo-first metatarsal angle. Patients were divided into progressive and nonprogressive groups. Binary logistic regression analysis was performed to identify factors that significantly affected the progression of hallux valgus deformity. The correlation between change in HVA and changes in other radiographic indices during follow-up was analyzed. The DMAA ( P = .027) and AP talo-first metatarsal angle ( P = .034) at initial presentation were found to be significant factors affecting the progression of hallux valgus deformity. Change in the HVA during follow-up was significantly correlated with changes in the IMA ( r = 0.423; P = .001) and DMAA ( r = 0.541; P < .001). The change in the HVA was found to be significantly correlated with changes in the IMA and DMAA. A future study is required to elucidate whether this correlation can be explained by the progressive instability of the first tarsometatarsal joint. We believe special attention needs to be paid to patients with pes planus and increased DMAA. Level III, comparative study.