Hallux Valgus Group Research Articles

A PARTIAL FUNCTIONAL RESTORATION AFTER HALLUX VALGUS CORRECT SURGERY - A CONTROLLED PRELIMINARY STUDY

Introduction: Hallux valgus is the most common condition found in the foot, caused by a progressive failure of the first ray stabilization means. The hallux is deviated into valgus, the first metatarsal into varus, and their association leads to a subluxation of the metatarsophalangeal joint of the first ray. Surgery is a treatment frequently used to correct this condition. So, is the static postural balance altered after corrective surgery?Materials and Method: 23 subjects participated in the study, all women, divided into two groups: control and hallux valgus. The hallux valgus group was evaluated three months post-operatively. Bipodal tests were carried out on a stabilometry platform, one with eyes open and one with eyes closed. The pressure center parameters were recorded and analyzed, such as the length or the area of the pressure center.Results: The results obtained showed significant differences between the two groups and were statistically significant, with a p-value of 0,05. The pressure center values are higher in the hallux valgus group.Conclusion: Some results found in the literature agree with the results of the present study. There are significant deficits in the static postural balance three months after corrective surgery. Other studies with a larger sample may be performed to confirm or not the results of this study.

Hallux Valgus And Walking Speed Influence Frontal Plane Net Joint Moments In Older Adults

Hallux valgus (HV) is often comorbid with knee osteoarthritis (OA) in older adults. Both these conditions are known to adversely affect walking mechanics, but the biomechanical link between these conditions has not been established. Peak external knee adduction moment is a surrogate measure of knee OA severity and progression. However, this variable is sensitive to changes in walking speed. PURPOSE: To examine the effects of HV on peak external knee adduction moment while walking at controlled slow and fast speeds. METHODS: Nineteen older adults (65-80 years) with moderate-to-severe HV and 19 healthy older controls completed five walking trials at controlled slow (1.0 m·s-1) and fast (1.3 m·s-1) speeds. Three-dimensional lower extremity marker position and ground reaction force data were collected at 100 and 1000 Hz, respectively. External knee adduction moment was calculated using an inverse dynamics approach. Peak moments were identified for the more affected leg for the HV group and dominant leg for the control group for each trial. Two-way mixed model ANOVAs were used to examine the effects of group (HV vs. control) and speed (1.0 vs. 1.3 m·s-1) on peak external knee adduction moment. RESULTS: For peak knee adduction moment a group x speed interaction (p=0.035) was observed. With increase in walking speed external knee adduction moment increased (p<0.001), however, the HV group had twice as much of an increase in net peak knee adduction moment (16.6% greater; 0.53 ± 0.21 vs. 0.62 ± 0.25 Nm/kg) as compared to the control group (8.6% greater; 0.51 ± 0.13 vs. 0.56 ± 0.13 Nm/kg). CONCLUSIONS: Older adults with HV show altered knee joint mechanics at faster walking speeds. Knee adduction moment data suggest that older adults with HV may be at a greater risk for developing knee osteoarthritis.

Correlation between functional ability, toe flexor strength, and plantar pressure of hallux valgus in young female adults: a cross-sectional study

BackgroundThe prevalence of hallux valgus (HV) increases with age in females. Several studies have investigated the relationship between foot problems, including HV, and falls in older individuals. This study aimed to examine whether HV causes a decline in functional activity in young females and also evaluate the relationship between HV angle, functional activity, toe flexor strength, and plantar pressure.MethodsWe assessed 94 females (mean age, 19.6 ± 1.3 years; mean body mass index, 21.2 ± 2.0 kg/m2) not currently receiving treatment for lower limb disease. HV angle was determined using their footprint. Functional reach (FR) and maximum step length (MSL), toe flexor strength, and plantar pressure were measured. Plantar pressure was measured during walking. We also calculated FR and the pressure in eight regions (first toe, second through fifth toes, first metatarsal, second through fourth metatarsals, fifth metatarsal, midfoot, medial heel, and lateral heel).ResultsThere were 39 and 55 participants in the HV and no HV groups, respectively. FR and MSL did not differ significantly between the HV and no HV groups. Toe flexor strength was significantly different between the HV and no HV groups (26.69 ± 9.68 vs. 32.19 ± 8.55, respectively) (p = 0.002, β = 0.206). During walking, plantar pressure was significantly lower in the second through fifth toes in the HV group (p = 0.005, β = 0.187). During FR, plantar pressure was significantly greater in the first metatarsal in the HV group (p = 0.016, β = 0.338). HV angle was negatively correlated with toe flexor strength (r = − 0.315, p = 0.002, β = 0.121) and plantar pressure during walking in the second through fifth toes (r = − 0.362, p < 0.001, β = 0.047), and positively correlated with plantar pressure during FR in the first metatarsal (r = 0.308, p = 0.002, β = 0.137). Toe flexor strength was negatively correlated with plantar pressure during FR in the second through fourth metatarsals (r = − 0.318, p = 0.002, β = 0.115), and there was a positive correlation with MSL (r = 0.330, p = 0.001, β = 0.092).ConclusionsThis study confirmed that HV reduces toe flexor strength and affects forefoot pressure during walking and FR in young females. Moreover, the toe flexor strength affects MSL. Efforts to prevent the onset and deterioration of HV from a young age might help reduce the risk of falling when older.

The correlation between deformity and metatarsus projection area and the ratios of projection to all metatarsi in direct radiographs in hallux valgus cases

Aim: Hallux valgus (HV) is a common deformity where the hallux deviates laterally in the metatarsophalangeal joint. Although various radiographic measurements have been developed to assess HV, not all are considered universally necessary and the correlations between these methods were not determined. The present study aimed to investigate the correlation between the metatarsus (MT) projection area and the projection rates to all MTs and deformity observed in direct radiographs in HV cases.Material and Methods: We retrospectively analyzed foot radiographs of 100 female cases (20-60 years old). The cases were divided into two groups of 50 HV and 50 non-HV based on HV angles (HVA). HVA>15˚ was accepted as HV. The MT projection areas and the projection rates to all MTs, HVA, and intermetatarsal angle (IMA) were measured in HV cases. Paired t-tests were used to compare continuous numeric variables (Significance: p ≤ 0.05).Results: HVA was higher in HV cases (mean, 22.2˚) when compared to the non-HV group (mean, 7.4˚) (p = 0.000). There was no difference between the mean MT projection areas in HV and non-HV groups. While there was no significant difference between the ratios of the projection area in MT I, II, III and IV to total MT area in HV and non-HV groups, the ratio of the projection area of MT V to the total MT area was lower in HV cases when compared to that of the non-HV group (p = 0.027).Conclusion: Although it was observed that HV did not affect the projection area of each MT, when the total MT area was considered, it was observed that the projection area of MT V was lower. This finding supported that HV is a condition that affects the whole foot.

Accuracy of magnetic resonance imaging for diagnosing hallux valgus.

ObjectiveTo assess the accuracy of magnetic resonance imaging (MRI) for the diagnosis of hallux valgus using radiography during weight bearing as the gold standard.Materials and MethodsThis was a retrospective analysis of all patients undergoing MRI of the foot and radiography of the foot during weight bearing at our institution between January and June of 2015. The hallux valgus angle (HVA) was measured on MRI and radiography. The Wilcoxon signed-rank test and simple linear regression were used in order to compare measurements. Patients were divided into two groups according to the HVA determined on radiography: > 15° (hallux valgus) and ≤ 15° (control). Qualitative and quantitative assessments of MRI scans were performed. For quantitative assessment, receiver operating characteristic curves were used in order to determine the HVA cutoff with the highest accuracy.ResultsA total of 66 MRI scans were included, 22 in the hallux valgus group and 44 in the control group. Wilcoxon signed-rank tests indicated a significant difference between the radiography and MRI measurements. Simple linear regression showed a nonlinear relationship between the measurements and values did not present a strong correlation. In comparison with the radiography measurements, MRI with an HVA cutoff of 16.4° exhibited the highest accuracy (86%). The accuracy of the subjective (qualitative) assessment was inferior to the objective assessment (measurement of the HVA).ConclusionHallux valgus can be diagnosed by measuring the HVA on MRI, satisfactory accuracy being achieved with an HVA cutoff of 16.4°.

P.641 Anxiety and insomnia as correlates of major depressive disorder with mixed features

The hypermobility theory of the first ray is the reason for the popularization of procedures such as the modified Lapidus procedure involving arthrodesis of the first tarsal–metatarsal joint for correction of hallux valgus deformity. Although many studies have involved motion of the first ray in hallux valgus patients, the presence and clinical significance of hypermobility in the first ray remains controversial. We performed a systematic review and meta-analysis to evaluate the difference in the first ray range of motion between patients with or without hallux valgus deformity. The databases used for the present review included Ovid EMBASE, Ovid MEDLINE, CINAHL, and the Cochrane Database. We searched for comparative studies that had evaluated the motion of the first ray in patients with or without hallux valgus. After screening for inclusion and exclusion criteria, we identified 3 studies that were relevant to our study question. All 3 studies showed more first ray motion in the hallux valgus group. Our quantitative synthesis showed a mean difference in the range of motion of the first ray of 3.62 mm (95% confidence interval 2.26 to 4.98) between those with and without hallux valgus deformity. Thus, we found statistically significantly increased first ray motion in patients with hallux valgus deformity compared with those without hallux valgus deformity. However, the clinical significance of this small amount of increased sagittal plane motion as a response to or a cause of hallux valgus remains unanswered.

Evaluation of the Association Between Plantar Fasciitis and Hallux Valgus.

The windlass mechanism, first described by John Hicks in 1954, defines the anatomical and biomechanical relationship between the hallux and the plantar fascia. Hallux valgus (HV) and plantar fasciitis are the most common foot disorders, and, to date, no study has evaluated the relationship between these disorders. The purpose of this study was to determine the incidence of and factors associated with plantar fasciitis in patients with HV deformity. In this prospective observational study, 486 patients with HV were divided into three groups according to stage of HV deformity. Patient sex, age, and body mass index were recorded. Presence of accompanying plantar fasciitis and heel spur was investigated by physical and radiographic examination. First metatarsophalangeal joint dorsiflexion of the affected side was measured. Patients with or without plantar fasciitis were also compared to evaluate factors associated with plantar fasciitis. Mean age and body mass index of the patients were significantly different among the three HV groups. The incidence of plantar fasciitis and heel spur significantly increased in correlation with the severity of HV deformity. Increased age and HV stage and decreased first metatarsophalangeal joint dorsiflexion were significantly associated with presence of plantar fasciitis in HV. In this study, the incidence of plantar fasciitis was significantly increased in correlation with the severity of HV deformity. Significant association was found between plantar fasciitis and HV, which are anatomically and biomechanically related to each other by the windlass mechanism.

Does Hallux Valgus Exhibit a Deformity Inherent to the First Metatarsal Bone?

Hallux valgus is a common condition, and it still poses some challenges. The identification of factors associated with the development of the deformity is of paramount importance in obtaining a full correction of the disorder. Hallux pronation is one of the frequently found components, especially in larger deformities, but the cause and exact location of this condition are not fully understood. The aim of the present study was to investigate whether there is a rotational deformity inherent to the first metatarsal bone. A case-control study was conducted on patients with and without hallux valgus who were subjected to computed tomography with multiplanar reconstruction. Statistical analysis was performed by means of a mixed model adjusted for foot and gender to compare metatarsal rotation between cases and controls. Correlations between numerical quantitative measurements were investigated by means of Pearson's correlation coefficient obtained in a linear mixed model. A total of 82 feet (tests) were analyzed in the hallux valgus group and 64 feet (tests) in the control group (N = 146). The hallux valgus group was significantly different from the control group (p< .001). Mean metatarsal bone rotation was 15.36° (range 1.65° to 32.52°) in the hallux valgus group and 3.45° (range −7.40° to 15.56°) in the control group. The difference between the means was 11.9° (confidence interval 9.2° to 14.6°). In conclusion, patients with hallux valgus exhibited increased exclusive bone rotation of the first metatarsal toward pronation compared with the population without this condition.

Three-Dimensional Weightbearing Assessment of the First Ray in Hallux Valgus: A Case-Control Study

Category:BunionIntroduction/Purpose:Coronal plane rotational deformity of the first ray has been implicated with the developmental pathologic process of hallux valgus (HV). Weight Bearing CT (WBCT) is an imaging technology that can support the assessment of this complex three-dimensional (3D) deformity. The objective of the study was to analyze the 3D architecture of the first ray in patients with HV when compared to controls using WBCT images and a 3D biometric algorithm analyzing the deformity in all three planes. We hypothesized that WBCT would confirm the rotational deformity in HV patients, and that the 3D algorithm would demonstrate increased specificity and sensitivity for the pathology when compared to traditional two-dimensional (2D) HV measurements such as the 1-2 intermetatarsal angle.Methods:Retrospective case-control study, ethics committee approved. Twenty-one feet of patients with clinically symptomatic HV and 20 feet of asymptomatic controls were included. Exclusion criteria applied were previous trauma or surgery affecting first ray or forefoot morphology. All patients were assessed using WBCT. First ray 3D coordinates (x, y, z) were harvested including: center-points of the heads and bases of the first and second metatarsals, center-point of the medial and lateral sesamoids, distal condyles of the proximal phalanx (PP) of the first toe, as well as the medial and lateral borders of the first metatarsal head and diaphysis. The 2D measurements (dorsoplantar 1-2 intermetatarsal (IMA) and metatarsophalangeal (MPA) angles) were obtained using digitally reconstructed radiographs (DRR). The Sesamoid Rotation Angle (SRA) was measured in the coronal plane. Using these coordinates, all 2D, 3D axes, distances, angulations and 3D biometric for HV (HV-3DB) could be calculated.Results:Mean ages were respectively 62.2y in the HV group and 48.8y in the control group (p<0.05). In 2D, the mean IMA and MPA for HV/controls were respectively 14.9/9.3 (p<0.001) and 30.1/13.1 (p<0.001). The SRA were respectively 29.1/7.1 (p<0.001). We found an almost perfect positive correlation between P1 rotation and sesamoid rotation, good correlation between IMA, MPA and SRA angles. There was poor correlation between pronation angles of the 1st phalanx and the 1st metatarsal. The 3D biometric algorithm combining IMA, MPA and SRA had a sensitivity of 95% and a specificity of 95.2% for the diagnosis of HV, compared to 90%/85.6% for the IMA and 90%/90.5% for the SRA.Conclusion:This original study confirmed our hypotheses. Weight Bearing CT efficiently analyzed the 3D architecture of the 1st ray in HV patients compared to asymptomatic controls. We concur with previous findings described in the literature concerning increased pronation of the 1st ray in HV. A novel biometric for HV using a specific multidimensional algorithm which combined IMA, HVA and SRA in a single 3D measurement, demonstrated increased sensitivity and specificity compared to the conventional 2D 1-2 intermetatarsal angle for the diagnosis of HV.

Correlation of the Hallux Sesamoids' Orientation with Various Anatomical Parameters in Patients with Hallux Valgus Deformity.

IntroductionAn awareness of the anatomical parameters of the foot such as the position and orientation of the sesamoid bones can be of great value for the etiology and diagnostic approach to patients with hallux valgus (HV). The purpose of this study was to evaluate the basic anatomical features and measurements related to the characteristics of HV in cadaveric material.Materials and methodsThe study sample included 12 cadaveric limbs with HV and 10 cadaveric limbs without HV as a control group. We measured the HV angle (HVA), the first to second intermetatarsal angle (IMA), and the first to fifth IMAs of all samples. We also recorded the shape of the first metatarsal head and the position/orientation of the sesamoid bones.ResultsThe mean values of the HVA (p = 0.000), the first to second IMA (p = 0.000), and the first to fifth IMA (p = 0.000) differed between the HV and non-HV group. The position of the sesamoid ossicles between the HV and the non-HV group was statistically significant (p = 0.001). While we noted the round shape of the first metatarsal head was predominant in HV samples, we found no statistically significant difference in the first metatarsal head shape between the test and control groups.ConclusionThe HVA, the first to second IMA, the first to fifth IMA, and the orientation of the sesamoid ossicles differed significantly between cadaveric samples with HV and those without HV.

The influence of hallux valgus and flatfoot deformity on metatarsus primus elevatus: A radiographic study

BackgroundMetatarsus primus elevatus (MPE), a dorsal elevation of the first metatarsal in relation to the lesser metatarsals on lateral-view radiographs, is an indicator of hallux rigidus. The angle between the articular surfaces of the base of the first metatarsal and the anterior part of the medial cuneiform (M1C1A) reflects the sagittal instability of the first tarsometatarsal (TMT) joint. MPE may also indicate instability of the first metatarsal. The purpose of this study was to identify the influence of hallux valgus (HV) and flatfoot (FF) deformities on measurements obtained from first metatarsal-related radiographic images. MethodsStanding radiographic images of 134 feet were investigated. In dorsoplantar-view radiographs, HV and intermetatarsal angles were evaluated. The position of the medial sesamoid was classified with a grading system (Hardy score). In lateral-view radiographs, MPE, M1C1A, and Meary's angle were measured. The subjects were divided into 4 groups: the normal group (G1), HV(−)FF(−); the HV group (G2), HV(+)FF(−); the FF group (G3), HV(−)FF(+); and the dual group (G4), HV(+)FF(+). The radiographic parameters were compared among the groups. ResultsMPE in the HV patients (G2 and G4) was less than that in the non-HV participants (G1 and G3). MPE in G4 was less than that in G3. The odds ratios of the Hardy score were higher in G2, G3 and G4 than in G1. The ratios were higher in the FF patients (G3 and G4) than in the non-FF participants (G1 and G2) and were higher in G4 than in G2. ConclusionsFF affects sesamoid dislocation, and the combination of HV and FF further increases sesamoid dislocation. Combined with M1C1A and the Hardy score, MPE may be a useful indicator of three-dimensional instability of the first TMT joint. First TMT joint-related operations may be considered for severe HV treatment in G4 patients.

Lower Limb Loading Character of Hallux Valgus Group Based on Detailing Medical Imaging Control

Lower Limb Loading Character of Hallux Valgus Group Based on Detailing Medical Imaging Control

Comparison of Plantar Pressure Distribution Between Postoperative Hallux Valgus Feet and Healthy Feet

Proximal crescentic osteotomy (PCO) in patients with moderate-to-severe hallux valgus (HV) is a well-established and effective procedure for correcting the deformity. However, there are no published studies comparing plantar pressure in postoperative HV feet with healthy feet. This study aimed to compare the plantar pressure distribution in postoperative HV feet with healthy feet. Twenty-six patients were included in the HV group, and 24 healthy participants were included in the control (C) group. All patients in the HV group underwent unilateral PCO. After undergoing PCO, this group was defined as the OP group. All subjects were women with no significant differences in age, height, weight, and body mass index. There were no significant differences in demographic characteristics between patients in each group. We divided the subjects' feet into 8 regions and measured the peak pressure (Peak-P), maximum force (Max-F), contact time, contact area, and the force-time integral in each region. All parameters of the great toe were significantly higher in the OP group than in the HV group. All forefoot parameters were not significantly different between the 2 groups. No parameter of the great toe was significantly different between the OP and C groups. However, mean Peak-P and Max-F of the central forefoot were significantly higher in the OP group than in the C group. PCO can improve the plantar pressure of the great toe in patients with moderate-to-severe HV to a level similar to that in healthy subjects. Level III, comparative study.

Evaluation of plantar pressures in people with hallux valgus using principal component analysis.

Foot deformities are serious problems in the elderly as they increase the risk of falling. This study aimed to examine the relationship between foot plantar pressure during gait and hallux valgus (HV). Foot-pressure data were recorded using an F-scan II system. We analyzed the entire waveform of plantar pressure during gait from 37healthy adults using principle component analysis (PCA), conducted using a 370 × 357matrix of time-normalized plantar data of 7areas during gait (5gait trials × 2 (both feet) of 37participants × 51data points × 7plantar areas). Two-way (plantar pressure × presence or absence of HV) analyses of variance were conducted on the principal component scores (PCSs) of principal component vectors (PCVs) 1 through 5, each of which exhibited more than 5% variance. The PCA clarified that the 2nd, 3rd, and 5th PCVs (PCV2, 3, and 5) were related to HV (p< 0.01). These PCVs exhibit a significant interaction between plantar pressure area and HV presence. The larger plantar pressure of the HV group around the hallux area during walking compared with the non-HV group is a dominant difference in plantar pressure features due to HV.

Pilot Study of a 3-Dimensional Method for Analysis of Pronation of the First Metatarsal of Hallux Valgus Patients.

The current work sought to quantify pronation of the first metatarsal relative to the second metatarsal and of the proximal phalanx of the great toe relative to the first metatarsal. Three-dimensional models were reconstructed from weightbearing computed tomography (CT) images (10 hallux valgus, 10 normal). The orientations of bones related to hallux valgus (HV) (ie, the phalanx, first and second metatarsals) were determined from coordinate systems established by selecting landmarks. After determining the hallux valgus and intermetatarsal angles, additional calculations geometrically determined the 3-dimensional (3D) angles using the aeronautical system of yaw-pitch-roll. The 3D geometrically determined angles were compared to the conventional plain radiographic angles. HV measurements taken with CT and 3D computer-aided design (3DCAD) geometric methods were the same as measurements taken from plain radiographs (P > .05). The average pronation of the first metatarsal relative to the second metatarsal was 8.2 degrees greater in the hallux valgus group (27.3 degrees) than in the normal group (19.1 degrees) (P = .044). A regression analysis of pronation vs intermetatarsal angle (IMA) was not found to be significant. There was also no correlation between pronation of the great toe and first metatarsal in the HV group. The pronation angle of the first metatarsal relative to the second metatarsal between normal and hallux valgus patients was larger in HV patients but was not well correlated with the IMA. The findings of this study indicate that pronation may need to be considered in the operative correction of hallux valgus for restoration of normal anatomy.

Analysis of Gait and Footprint in Patients with Hallux Valgus

Category: Midfoot/Forefoot Introduction/Purpose: Hallux valgus (HV) is one of the most common forefoot problems. HV is defined as a hallux valgus angle of more than twenty degrees. HV can lead to alterations of the plantar pressure pattern and clinical gait. This study examined the relationship between gait alterations and HV deformities. Methods: We examined 500 residents (161 men and 339 women; &gt;50 years of age) of Miyagawa village in Mie, Japan in 2009, 2011 and 2013. They performed a 6-meter walk test at normal and maximum speed. We examined gait speed, the number of steps, and footprint between patients with normal (HV angle &lt;20; n=350) and HV (HV angle &gt;20; n=150), and between normal-to-mild (HV angle &lt;30; n=436) and moderate-to-severe (HV angle &gt;30; n=64). Their plantar pressure patterns were measured using a gait analyzer (Walk Way MW 1000; Anima, Tokyo, Japan, Figure.1). Statistical analyses were performed using the chi-square test according to sex and use of the hallux ball; the t-test according to age, height, and weight; and logistic regression analysis adjusted for age, sex, and height according to gait speed and the number of steps. P value less than 0.05 was considered significant. Results: With regard to the plantar pressure pattern, the percentage of subjects in the HV group who left a footprint of the hallux ball was significantly lower than that in the normal group. The percentage of subjects in the moderate-to-severe group who left a footprint of the hallux ball was even lower. Analysis of the footprint revealed that the HV group used the hallux ball significantly less during toe-off than the normal group. At both normal and maximum speed, the number of steps and gait speed did not differ significantly between the normal and HV groups. However, when we compared normal-to-mild and moderate-to-severe groups, the number of steps in the moderate-to-severe group was significantly greater than in the normal-to-mild group at maximum walking speed. Conclusion: Analysis of the footprint revealed that the percentage of subjects in the HV group who was able to use the hallux ball during toe-off was significantly less than that in the normal group. The percentage of subjects in the moderate-to-severe group who could use the hallux ball in toe-off was even lower. HV can cause footprint alterations. Moderate-to-severe HV can cause not only footprint alterations but also gait alterations, especially when walking at maximum speed.

Pronation of the First Metatarsal in Hallux Valgus Deformity

Category: Bunion Introduction/Purpose: Hallux Valgus is a common condition often resulting in chronic pain and disability. However, the precise etiology of Hallux Valgus deformity remains poorly understood and likely results from a combination of intrinsic and extrinsic factors. There is conflicting evidence regarding as to whether hallux valgus deformity is associated with increased pronation of the first metatarsal. The purpose of this study was to investigate the correlation between hallux valgus and pronation of the first metatarsal in relation to other structural parameters of the foot. Methods: Eighty-five consecutive patients with clinically and radiographically diagnosed hallux valgus, pes planus, or cavovarus that underwent imaging with weightbearing CT between January 2014 and May 2016 were retrospectively enrolled and compared to a control group consisting of patients who with scans completed for indications unrelated to hallux valgus (e.g. ankle arthritis) and were determined to have normal foot structure. Using a weightbearing CT axial view, the alpha angle of the first metatarsal was measured and correlated with other radiographic parameters on plain weightbearing radiographs including Meary’s angle, hallux valgus angle, intermetatarsal angle, and calcaneal pitch. Results: There were 39 males and 46 females (91 feet) with a mean age of 47.16 (SD14.89) years and BMI of 32.99 (SD 7.35) kg/m2 included in this study. Mean pronation of the first metatarsal significantly (p&lt;0.001) different in all group compared to the control: 15.23 (SD 7.96) in the hallux valgus group, 15.22 (SD 8.56) in the pes planus group, negative 0.23 (SD 5.99) in the cavovarus group, and 6.98 (SD 5.09) in the control group. There was moderate correlation between meary’s angle, tripod index, calcaneal pitch, and the alpha angle (negative 0.70, 0.65, negative 0.53, respectively) with a p-value &lt; 0.001. HVA demonstrated little correlation with the measured alpha angle (0.23), p&lt;0.03. Conclusion: Patients with hallux valgus deformity demonstrated a significantly higher pronation of the first metatarsal compared to the control group. However, a greater number of patients in the hallux valgus group had flatfoot deformity and further analysis revealed a greater correlation between foot type and pronation of the first metatarsal. Weightbearing CT is a reasonable way to image complex forefoot deformities prior to bunion surgery and it is important to take into account rotation of the first metatarsal in bunion surgery.

Influence of Foot Position on the Measurement of First Metatarsal Pronation Using the First Metatarsal Axial Radiographs

Category: Other Introduction/Purpose: In hallux valgus (HV) surgery, the importance of correcting first metatarsal (1MT) pronation, as well as correcting adduction, has been increasingly recognized. A 1MT axial radiograph is a simple method to quantify 1MT pronation (see figure). However, this view does not provide the exact axial projection, and 1MT is angled on the image. Furthermore, the 1MT angle is dependent on the foot position and alignment. Therefore the measured pronation angle on the radiograph may not be the same as the “true” pronation along the 1MT long axis. The purposes of this study were to 1) quantify the difference between the measured 1MT pronation on the axial radiograph and the true pronation angle, and 2) determine the influence of foot position on the measurement. Methods: CT images of 10 feet from HV patients (HV group; age, 58 years; HV angle, 44°) and 10 feet from those without HV (non-HV group; age, 47years; HV angle, 12°) were obtained. Digitally reconstructed radiographs of the 1MT were generated from the CT images in a three-dimensional virtual space (see figure). 1MT was pronated along the long axis (true pronation angle). Then, images with different plantarflexion (25° to 35° in 5° increments) and adduction (-10° to 10°) angles were created. This procedure was repeated for different pronation angles (-10° to 30°), and 135 simulated 1MT axial radiographs were obtained from each bone. We measured the 1MT pronation angles in all images. Differences in the measured pronation angle and true pronation angle were calculated for each group. Correlations between the measurement difference and 1MT plantarflexion/adduction angles were assessed using the Spearman correlation coefficient. Results: The mean measurement differences were 0.7° and 1.0° for the HV group and non-HV group, respectively. The standard errors of the measurement were 0.5° and 0.6° for the HV group and non-HV group, respectively. There was no significant correlation between the measurement difference and plantarflexion angle (P = 0.92 and P = 0.92 for the HV group and non-HV group, respectively), nor between the measurement difference and adduction angle (P = 0.82 and P = 0.74). Conclusion: The measurement differences were low in both HV and non-HV feet, indicating that the 1MT pronation angle measured on the axial radiograph represented the true pronation angle along the long axis of 1MT. The measurement differences were consistent regardless of plantarflexion and adduction angles. Therefore, a variation of 1MT angle on the image, which can be caused by the misalignment of foot position while taking the radiograph and difference in foot alignment (such as flatfeet and cavus feet), did not affect the measurement. 1MT axial radiograph could be used as a valid and robust method to quantify 1MT pronation.

Posição do sesamoide lateral em relação ao segundo metatarso em pés com e sem hálux valgo

ObjectivesDetermine if the sesamoids migrate laterally in the feet with hallux valgus or if they only appear to move, maintaining their relationship with the other structures of the forefoot. MethodsRadiographs of the anteroposterior incidence of 80 patients (94 feet) were evaluated in the years 2015 and 2016, with the feet under load. Of these, 48 had a valgus hallux angle greater than 15 (hallux valgus group) and 46 had a hallux valgus angle less than 15 (control group). The distances of the head of the first metatarsal and of the lateral sesamoid to the axis of the second metatarsus were measured. Subsequently, the coefficients of these distances were measured by the length of the second metatarsal in order to adjust for the different foot sizes. ResultsBoth the absolute measure and the relative measure of the head from the first metatarsal to the second metatarsal were significantly different in the two groups, having a positive correlation with the valgus hallux and intermetatarsal angles. However, neither the absolute nor the relative distance of the lateral sesamoid to the second metatarsal were different in the two groups, as they did not correlate with the valgus hallux and intermetatarsal angles. ConclusionsDespite the medial deviation of the first metatarsus in hallux valgus, the sesamoid maintains its relation with the second metatarsal in the transverse plane. This apparent lateral displacement may lead to misinterpretation of these radiographs. This fact is of paramount importance in the pre‐, intra‐, and postoperative period of patients with hallux valgus.

First Metatarsophalangeal Joint Arthrodesis in Hallux Valgus Versus Hallux Rigidus Using Cup and Cone Preparation Compression Screw and Dorsal Plate Fixation.

Various techniques have been described for first metatarsophalangeal (MTP) joint arthrodesis. The purpose of this study was to determine if cup and cone preparation by a single surgeon with an interfragmentary screw and dorsal plate fixation provides a comparable union rate in hallux valgus versus hallux rigidus. Our study included all patients who underwent first MTP joint fusions using cup and cone preparation with an interfragmentary compression screw and dorsal plate fixation from 2010 to 2015. We compared union rates in 65 patients with hallux rigidus with 47 who had hallux valgus. One of 65 hallux rigidus cases developed non-union and underwent revision surgery. One of 47 patients in the hallux valgus group developed a painless non-union. All other patients achieved union based on post operative radiographs. Our rate of painful non-union was 1.5% for hallux rigidus and 0% for hallux valgus, which is lower than recent published literature of 7% for hallux valgus and 3.7% for hallux rigidus. We found no difference between the two groups suggesting this method may provide stronger fixation and may be preferable when dealing with hallux valgus. First metatarsophalangeal joint fusion in patients with severe hallux valgus and hallux rigidus, using spherical reamers, compression screw and dorsal plate fixation is equally successful at achieving clinical and radiographic fusion in both hallux valgus and hallux rigidus.