M1M2 Angle Research Articles

Ostéotomie Scarf dans le traitement de l’hallux valgus: À propos de 123 cas avec un recul moyen de 4,8 ans

Purpose of the study Many different osteotomies can be used for the treatment of hallux valgus. The purpose of this study was to evaluate the Scarf osteotomy associated or not with phalangeal osteotomy and to search for deformation cutoff points beyond which corrections appear to be difficult to achieve. Material and methods This retrospective analysis included 87 patients (123 feet) among 130 who underwent hallux valgus surgery between October 1993 and November 2000. Mean follow-up was four years eight months. The serie included 83 women and 4 men. Mean age at surgery was 53.5 years. A Scarf diaphyseal osteotomy was performed in all patients associated or not with phalangeal osteotomy. Each patient was reviewed clinically and radiographically with anteroposterior and lateral views of the foot in the standing position. Results 84.6% of the patients were satisfied or very satisfied. There was a correlation between the index of satisfaction and clinical symptoms (metatarsalgia, stiff hallux, pain over exostosis). There was a statistically significant decrease in hallux valgus (31.2° to 17.5°), of metatarsus varus (12.1° to 7.5°), and articular angle of the distal metatarsus (13.3° to 11.1°). Patients who had phalangeal osteotomy achieved the best hallux valgus correction (15° versus 21.4°). Mean shortening of the first metatarsus was 2.2 mm with a decrease in the metatarsus-ground angle (19° versus 20.1°). Cutoff limits for deformations which are difficult to correct satisfactorily were M1M2 angle ≥ 15° and distal metatarsal articular angle ≥ 13°. The overall Groulier score showed 70.7% very good and good results, 27.6% fair results and 1.7% poor results. Discussion The Scarf technique is a reliable method to achieve significant correction of hallux valgus deformation. It requires a rigorous technique with specific attention to the elevation of the first metatarsus and excessive shortening, two factors favoring metatarsalgia. Adding a phalangeal osteotomy can improve the radiological result, but it is very difficult to obtain satisfactory correction if the initial deformations are severe and associated. Rotation of the plantar fragment helps for better orientation of the articular surface of the first metatarsus but limits the correction of the metatarsus varus. Function is the basic objective of hallux valgus surgery and patient satisfaction is related solely to clinical symptoms.

慢性関節リウマチの前足部変形について

Hallux Valgus is a common disorder in women. In addition, it is a typical deformity of the rheumatoid foot.To investigate differences in the deformity pattern between rheumatoid and non-rheumatoid hallux valgus, we carried out radiographical measurements of a number of feet parameters.The RA group consisted of 26 patients (52 feet), who were treated at the Department of Orthopaedic Surgery, Kyushu University.The non-RA group consisted of 70 patients (121 feet), who had a correction osteotomy for hallux valgus at Kyushu Chuo Hospital.The average hallux valgus angle in the RA group was 25.9 degrees, and in the non-RA group was 33.0 degrees. The M1M2 angle was 11.9 degrees in the RA group, and 17.3 degrees in the non-RA group.Investigating relationship between the two angles, the M1M2 angle was found to have a significant influence on the hallux valgus angle in the non-RA group, but not in the RA group.

Secular changes in the angle of divergence of the first two metatarsals in the Japanese.

This investigation concerns secular changes of the intermetatarsal M1-M2 angle in the foot of Japanese, from the prehistoric Jomon period to early modern times. The divergence of the first metatarsal from the second in both sexes in the reconstructed tarsometatarsal bones gradually decreased during this period. In addition, the difference between sexes or sides in each period is small and statistically insignificant. With time, the first metatarsocuneiform angles, in both sexes, also decreased in parallel with the reduction of the intermetatarsal M1-M2 angle, while the second metatarsocuneiform angles in both sexes increased. Both may play a role in decrease of the intermetatarsal M1-M2 angle. A conspicuous angular divergence of the first metatarsal from the second one occurred in comparatively recent times. This change would be accelerated by modification in life-style, together with the effects of footwear.

Influence d'une orthèse pour le maintien de l'ouverture de la première commissure dans la rhizarthrose

Trapezometacarpal osteoarthritis of the thumb includes an progressive aspect in the form of contracture of the first web. The wearing of a C-shaped bar splint is designed to prevent this contracture. The heat-molded plastic splint used by the authors is characterised by the following 3 points: reduction, stabilisation and comfort. The authors have systematically evaluated the action of the splint by measuring the variations in the M1M2 and TM1 angles on X-rays with and without the splint. Analysis of the quantitative data and of the X-rays shows an improvement in the opening of the first web and a reduction in the subluxation of the trapezometacarpal joint. Although they did not analyse the intrinsic process, the authors also noted a very marked reduction in pain (90% of cases) by wearing the splint.