Metatarsal Head Research Articles

The effectiveness of shoe modifications and foot orthoses in conservative treatment of lesser toe deformities: a review of literature.

Forefoot disorders are prevalent in the general population, with an incidence between 2 and 20%. Among them, lesser toe deformities (hammer, claw, and mallet toes) are frequent disorders, and their conservative management is often not adequately considered but usually attempted before surgical indication. Among conservative treatments, shoe modifications and the application of orthoses may, in most cases, alleviate symptoms. From a careful analysis of the available literature, it emerged that treatment approaches should be individualized, and patient education has to be a central aspect of therapy. Proper footwear includes rocker and cushioned soles shoes, a wide toe box, proper length, and a lowered heel, eventually combined with the placement of a felt pad. Narrowed shoes must be avoided, limiting the impaction of the distal phalanx and toenail into the ground. A custom-made silicone orthosis applied at the second digit metatarsophalangeal (MTP) joint in a hammer or claw toe seems to reduce mean peak plantar pressure in the rigid stage of deformity but not the flexible one. A metatarsal pad placed 6.5mm proximal to the second metatarsal head was demonstrated to diminish peak pressures by 33%, and a 12.5-mm insole further reduced peak metatarsal head pressures by 23% compared with a 2.5-mm insole. The best comfort of orthoses seems to be given by treating metatarsalgia resulting from deformities such as MTP joint instability, mallet, and claw toe. Little orthotic relevance is given to deformities such as hammer toes. Although the most significant obstacle appears to be the psychological aspect of patients, who must accept the placement of compensatory orthoses, some studies show that all these management appear to be often beneficial for the treatment of these disorders. However, none of them are permanent solutions to the deformity and they can be treatment of choice just in advanced stages, in elderly and low functional demand patients.

Gait performance changes after ten cervical retractions

Background and Study Aim. Students are prone to spine overloading, as they often spend prolonged periods in unfavorable postures. They tend to struggle with balancing study time and leisure physical activity. The head and neck regions are particularly rich in proprioceptors. Prolonged forward head posture (protraction) can lead to balance disturbances. This, in turn, affects gait and overall body posture. The aim of this study was to examine the effects of a series of corrective active head exercises on gait, a fundamental form of movement, in a group of healthy university students. Material and Methods. Gait patterns were assessed in 10 healthy male full-time students with an average age of 22.8 years (SD = 1.1). The assessment was based on the regional distribution of plantar pressure across two measurement sessions. One session was conducted before, and one after performing 10 active head retractions. Gait changes were analyzed in ten foot regions for 200 steps of each participant. Results. After 10 cervical retractions, a decrease in pressure, ground reaction force, contact time, and area values was observed in the 1st metatarsal head (1MTH). Conversely, an increase in these quantities was found in the toes. Additionally, there was a tendency toward a decrease in the contact area of the heel and 3rd metatarsal head (3MTH), along with increased contact time in the midfoot. Performing 10 neck retractions altered gait by inducing heel supination. It also increased hallux involvement in propulsion and widened the base of toe support. Conclusions. Even a few movements that correct head protraction have an immediate effect on whole-body movement. This effect suggests potential benefits of incorporating neck retractions into physical education programs for students. Even when time-consuming forms of regular exercise are not feasible, performing just a few neck-correcting movements can positively impact overall body movement.

Smart Compression Sock for Early Detection of Diabetic Foot Ulcers

The prevention of diabetic foot ulcers remains a critical challenge. This study evaluates a smart compression sock designed to address this issue by integrating temperature, plantar pressure, and blood oxygen sensors and monitoring data recorded by these sensors. The smart sock, developed with input from a certified Pedorthist, was tested on 20 healthy adult participants aged 16 to 53. It includes four temperature sensors and pressure sensors at common ulcer sites (first and fifth metatarsal heads, calcaneus, and hallux), and a blood oxygen sensor on the hallux. The sensors are monitored, and their transduced data are collected and stored through an app installed on a personal cell phone. The mobile app interface is user-friendly, providing intuitive navigation and easy access to the sensors’ data. Using repeated measures ANOVA and post hoc tests, we analyzed the impact of various physical activities on physiological changes in the foot. The device effectively detected significant variations in blood oxygen, temperature, and pressure across six activities. Statistical analyses revealed significant differences based on activity type and sensor location. These results highlight the smart sock’s sensitivity and accuracy, suggesting its potential to prevent diabetic foot ulcers. Further clinical trials are needed to evaluate its efficacy in a larger, more diverse population.

Comparing the Ground Reaction Forces, Toe Clearances, and Stride Lengths of Young and Older Adults Using a Novel Shoe Sensor System

In this study, we developed a lightweight shoe sensor system equipped with four high-capacity, compact triaxial force sensors and an inertial measurement unit. Remarkably, this system enabled measurements of localized three-directional ground reaction forces (GRFs) at each sensor position (heel, first and fifth metatarsal heads, and toe) and estimations of stride length and toe clearance during walking. Compared to conventional optical motion analysis systems, the developed sensor system provided relatively accurate results for stride length and minimum toe clearance. To test the performance of the system, 15 older and 8 young adults were instructed to walk along a straight line while wearing the system. The results reveal that compared to the young adults, older adults exhibited lower localized GRF contributions from the heel and greater localized GRF contribution from the toe and fifth metatarsal locations. Furthermore, the older adults exhibited greater variability in their stride length and smaller toe clearance with greater variability compared to the young adults. These results underscore the effectiveness of the proposed gait analysis system in distinguishing the gait characteristics of young and older adults, potentially replacing traditional motion capture systems and force plates in gait analysis.

The Direct Impact Effect of Different Foot Orthotic Designs on the Plantar Loading of Patients with Structural Hallux Limitus: A Quasi-Experimental Study

Background: This study examines the effect of two types of custom-made foot orthoses (CFOs) in patients with structural hallux limitus (SHL). Methods: In this quasi-experimental, repeated measures study, 24 participants with SHL were sampled. Two CFOs—cut-out CFO and anterior stabilizer element (AFSE) CFO—were compared using minimalist SAGURO neoprene shoes: no foot orthoses (FO), cut-out CFO, and AFSE CFO. Plantar pressures and center of pressure (CoP) displacement were measured using a Podoprint® platform. Results: Both CFOs shifted the CoP medially during midstance (p < 0.001 with AFSE CFO and p = 0.0036 with cut-out CFO). The AFSE CFO showed a more anterior CoP in midstance, while the cut-out CFO affected anterior CoP in midstance and pre-swing. The AFSE CFO significantly increased pressure in the second toe, lesser metatarsal heads (MTH), midfoot, and rearfoot. In contrast, the cut-out CFO decreased pressure in the second MTH and lesser toe regions, increasing pressure in the midfoot and heel. Both CFOs lowered the hallux/first MTH ratio compared to shod without CFO. Conclusions: The cut-out CFO led to medial and anterior CoP displacement, reducing lateral foot and hallux pressure while transferring loads to the first MTH. The AFSE CFO caused a similar shift by increasing loads on the first MTH.

Comparison of third-generation minimally invasive surgery, split-drill osteotomy, and triplanar chevron osteotomy for treating mild to moderate hallux valgus with metatarsalgia in middle-aged women: An observational study.

This retrospective study compared the clinical efficacy of third-generation minimally invasive surgery (3rd-MIS) split-drill osteotomy with soft tissue release to that of triplanar chevron osteotomy (TCO) for treating mild to moderate hallux valgus (HV) with metatarsalgia in middle-aged women. This study compared the efficacy of 3rd-MIS using split-drill osteotomy to that of TCO in treating mild to moderate HV with metatarsalgia in 52 middle-aged women from March 2022 to June 2023. Retrospectively analyzing a total of 52 patients (26 patients per group), we employed 2 distinct surgical methods across 2 groups in this study: the TCO group received a traditional TCO accompanied by soft tissue release, whereas the MIS group underwent a split-drill osteotomy with soft tissue release. The study compared the operation time, onset of weight-bearing, osteotomy healing, blood loss, pre- and postsurgery X-ray measurements, metatarsalgia, and foot function scores. In the TCO group, complications included peri-incisional numbness, elevation of the first metatarsal head with metatarsalgia, and bone hyperplasia with stiffness at the MTPJ in one patient each. In the MIS group, bunions were successfully corrected without significant complications like bone nonunion or avascular necrosis of the metatarsal head, and the metatarsal length was preserved. Significant differences in operation time, weight-bearing onset, healing, and blood loss were detected between groups (P < .05). Preoperatively, there were no significant differences in hallux valgus angle, 1-2 intermetatarsal angle, or distal metatarsal articular angle among the groups (P > .05). Nonetheless, notable postoperative differences were observed (P < .05). Foot function and pain scores, assessed by the American Orthopaedic Foot & Ankle Society and the Visual Analogue Scale, showed significant improvements in both groups following surgery. Both surgical techniques effectively corrected the HV angle without significant changes in the first metatarsal length. The MIS group experienced significantly less pain on the second day postsurgery, as indicated by lower Visual Analogue Scale scores (P < .05). Both techniques were similarly effective in treating metatarsalgia. 3rd-MIS split-drill osteotomy with soft tissue release offers several advantages over TCO techniques for treating mild to moderate HV with metatarsalgia in middle-aged women, such as reduced trauma, quicker healing, smaller scars, and less pain after surgery.

Comparative study of dorsiflexion closing wedge osteotomy of the metatarsal head and osteochondral autologous transplantation for Freiberg disease treatment: A multicenter analysis

Freiberg disease (FD) is a condition characterized by osteochondrosis affecting the metatarsal heads, with the second metatarsal head being the most commonly affected. Dorsiflexion Closing Wedge Osteotomy of the Metatarsal Head (DCWMO) has been conventionally employed, whereas Osteochondral Autologous Transplantation (OAT) represents a more recent technique with restricted comparative research. This study aimed to compare the outcomes of DCWMO and OAT for treating Freiberg disease (FD). Groups were established among two institutions. Institution-1 has made the treatment with OAT (8 patients) and Institution-2 has made the treatment with DCWMO (8 patients). The primary outcomes collected, including complications, range of motion, length of the metatarsal, American-Orthopaedic-Foot-and-Ankle-Society–lesser MTP-interphalangeal (AOFAS-LMI) score, visual-analog-scale (VAS), Foot-and-Ankle-Disability (FADI) score, and Short-Form-12 (SF-12), were all compared. The Sport-FADI and activity-FADI scores at final follow-up were significantly greater in the OAT group than in the DCWMO group (94.04 vs 84.75 and 97 vs 92, P = 0.021 and P = 0.04, respectively), whereas plantarflexion at final follow-up was significantly lower in the DCWMO group than in the OAT group (43.13 vs 6.88 degrees, P < 0.001). The AOFAS-LMI score at final follow-up was significantly greater in the DCWMO group than in the OAT group (86.75 vs 75.38, P = 0.013). In conclusion, this study highlights the effectiveness of both OAT and DCWMO in treating Freiberg's disease, as evidenced by significant postoperative improvements in various functional scores, including AOFAS-LMI, VAS and FADI. Notably, OAT demonstrated favorable outcomes in SFADI and AFADI and plantarflexion ROM, while DCWMO led to improved the AOFAS-LMI score.Level of Evidence: Level 3

Exploring plantar pressure distribution in patients with newly diagnosed diabetes: Implications for foot ulcer prevention in an overweight Mexican population

IntroductionElevated plantar pressure (PP) constitutes a risk factor for developing foot ulcers. Once present, elevated PP increases morbidity and mortality in patients with diabetes. Given the high prevalence of overweight and obesity in the Mexican population, this study aimed to describe the magnitudes and the distribution of the PP observed in a sample of newly diagnosed patients with diabetes, adjusting for body mass index (BMI) groups (normal weight, overweight, grade I obesity, and grade II and III obesity). Materials and methodsA total of 250 volunteers attending a comprehensive care program for the management of type 2 diabetes received foot assessments that included vascular and neurological evaluation, the identification of musculoskeletal changes, and measurements of PP. ResultsDiabetic neuropathy and peripheral arterial disease were present in 21.6% and 11.2% of all participants. Musculoskeletal alterations were present in 70.8% of participants. A positive and significant correlation (p<0.001) was observed between BMI and the peak PP of all anatomical regions assessed. After adjusting for BMI, significant differences (p<0.001) were seen between groups. The metatarsal region, particularly under the third metatarsal head, denoted the highest magnitudes across all BMI. ConclusionsPeriodic PP assessment is recommended to identify the distribution of high-pressure points along the plantar surface. However, as a preventive measure, it is suggested to encourage patients with diabetes and overweight or obesity to wear appropriate footwear and pressure-relief insoles to relieve high-pressure areas – often seen in these populations – to help prevent foot complications.

Early effectiveness of modified minimally invasive Chevron-Akin osteotomy for moderate to severe hallux valgus

To explore early effectiveness of modified minimally invasive Chevron-Akin (MICA) osteotomy in the treatment of moderate to severe hallux valgus. A clinical data of 49 patients (61 feet) with moderate to severe hallux valgus, who met the selection criteria between December 2019 and October 2022, was retrospectively analyzed. There were 7 males (8 feet) and 42 females (53 feet) with an average age of 38.0 years (range, 15-59 years), including 37 of unilateral foot and 12 of bilateral feet. There were 41 feet of moderate hallux valgus [hallux valgus angle (HVA) 20°-40°] and 10 feet of severe hallux valgus (HVA>40°). All patients underwent modified MICA osteotomy. A transverse osteotomy on the distal end of the first metatarsal bone was performed to replaced the traditional Chevron osteotomy, and three Kirschner wires were used to assist in three-dimensional correction. The other treatments were the same as traditional MICA osteotomy. The HVA, inter metatarsal angle (IMA), Hardy score of the sesamoid, and American Orthopaedic Foot and Ankle Society (AOFAS) score of 61 feet before operation and at last follow-up were recorded, and the results were compared between the various severity of hallux valgus. All patients were followed up 6-24 months with an average of 12.0 months. After operation, the redness and swelling around the incision occurred in 1 foot; limited mobility of the metatarsophalangeal joint occurred in 2 feet; mild numbness of the skin occurred in 5 feet; mild inversion of the great toe occurred in 2 feet. No complication such as tendon injury was found. X-ray films showed no abnormal healing, nonunion, or necrosis of the metatarsal head after osteotomy. The healing time of osteotomy ranged from 3 to 4 months, with an average of 3.2 months. At last follow-up, the HVA, IMA, Hardy score of sesamoid, and AOFAS scores all significantly improved when compared with preoperative levels ( P<0.05). The AOFAS scores were excellent in 45 feet, good in 15 feet, and fair in 1 foot, with an excellent and good rate of 98.4%. The above indicators for moderate or severe hallux valgus patients were significantly improved when compared with preoperative levels ( P<0.05). The changes between pre- and post-operation in HVA, IMA, and Hardy scores of severe hallux valgus were all greater than those of moderate hallux valgus, with significant difference in HVA change between groups ( P<0.05), while there was no significant difference in the other two changes ( P>0.05). Modified MICA osteotomy can achieve good orthopedic effects and early functional improvement in the treatment of moderate to severe hallux valgus.

Comparative clinical and radiographic results of three fixation systems for transverse subcapital osteotomy in treating hallux valgus

Objective: Compare three fixation models for Bosch osteotomy both clinically and radiographically.Methods: A retrospective comparative study was conducted on patients surgically treated for hallux valgus using Bosch osteotomywith three different fixation systems. The first group was treated with a temporary pin for three weeks; the second, received thesame pin plus a screw; and the third, used two screws without a pin. Radiographic analysis included the intermetatarsal angle,metatarsophalangeal angle, percentage of lateral shifting of the metatarsal head, dorsal or plantar migration of the metatarsal head,and consolidation time. Clinical evaluation was performed using the American Orthopaedic Foot and Ankle Society (AOFAS) scale.Complications during follow-up were recorded.Results: Twenty hallux valgus were included in each group. No significant differences were found in radiographic evaluations amonggroups in the preoperative and final follow-up, except that the third group showed less loss of correction. There were no significantdifferences in consolidation times. Clinical improvements were observed in all three fixation systems, with no significant differencesamong them according to the AOFAS scale.Conclusion: No significant clinical or radiographic differences were observed among the three fixation systems, except that the groupusing two screws showed less loss of correction. Level of evidence IV; Therapeutic studies; Case series.

Early Radiological Outcome of Hallux Valgus Corrective Surgery With an Intramedullary Plate: A Single-Center Case Series.

Hallux valgus is a common foot deformity that can lead to significant pain and functional limitations. Minimally invasive corrective surgery isbecoming increasingly popular. The aim of this study is to evaluate the radiological outcome ofmini-open hallux valgus surgery using an intramedullary plate in Asian patients. Aseries of seven patients (six females, one male) and 10 feet underwent hallux valguscorrectionsurgery. Three of the patients had bilateral surgery. Age ranged from 31 to 54 years old.All patients had severe pain and functional limitations. Thecases are mild to moderate in severity, of which the radiological parameters are the hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA). A Bosch osteotomy (distal metatarsal osteotomy) is performed, and a locking plate was inserted into themedullary canalwith the distal part of the plate displacing the metatarsal head laterally. The rotational deformity was corrected. The plate isfixed to the metatarsal head.Akin's osteotomy was performed in all cases. Patients were allowed to bear weight immediately after surgery and were followed up at regular intervalswith serialradiographs. Result: The follow-up period was three months. All patients were full weightbearing with minimal or no pain at three months. Wounds were well healed. Osteotomy sites were united, with significant radiological improvement (mean HVA: 24.1° to 7.2°; mean IMA: 17° to 7.8°; mean DMAA: 13.7° to 4.2°). Mini-open hallux valgus surgery using an intramedullaryplate is a safe and effective technique that can lead to significant improvement in pain and function for mild to moderate hallux valgus. The modifiedplacement of the plate into the medullary canal allows for a smaller incision while providing correction of the hallux valgus deformity.

An exploration of the agreement, inter- and intra-rater reliability, and reproducibility of three common methods used to measure minimum toe clearance with optical motion capture systems under three shoe conditions

BackgroundThe gait variable minimum toe clearance (MTC) has been investigated concerning trip-related fall research in older adults. However, comparing studies is difficult due to the different methods used to measure MTC and shoe conditions, which may affect agreement. Measurement methods can include using a single virtual point (SVP), multiple virtual points (MVPS), or metatarsal head markers (marker-based). The shoe types used in MTC studies include standard shoes (SS), personal shoes (PS), and barefoot (BF) conditions. Research questionWhat is the agreement, inter and intra-rater reliability, and repeatability for the 3 commonly used methods of measuring MTC (SVP, MVPS, marker-based) under the 3 shoe conditions for optical motion capture systems (SS, PS, BF)? MethodsTwelve healthy young adults (mean [SD] 23.8 [1.9] years,7 males) participated in this observational study. In a randomized order, participants completed 25 walking trials at self-selected normal and slow speeds in SS, PS, and BF conditions while infrared cameras recorded the maker trajectories. Each participant performed a familiarization trial for at least 1 minute before collecting data on each shoe condition. Statistical analyses included Bland-Altman 95 % limits of agreement (LOA) analyses, interclass correlation coefficient (ICC) analyses for inter- and intra-rater reliability, and the repeatability coefficient (RC). ResultsThe SVP and MVPS had a tighter 95 % LOA than the marker-based method, particularly under SS and BF conditions. The inter-rater reliability was good to excellent under these shoe conditions. Intra-reliability for all methods under all shoe conditions was excellent (ICC >.90). The RC was very similar for each method, with none exceeding 1.02 cm. SignificanceThe study provides estimates of the agreement between MTC methods and suggests that only SVP or MVPS produced similar results in SS/BF conditions. Additionally, a "true" change in MTC requires a difference greater than 1.02 cm.

Effect of different inner pressures of air insoles and walking durations on plantar pressure time integral

Air insoles have provided insights for reducing the risk of diabetic foot ulcers (DFU). The pressure time integral (PTI) is an effective assessment that considers the time effect in various physical activities. We investigated the interactions between three different insole inner pressures (80, 160, and 240 mmHg) and two walking durations (10 and 20 min). The big toe (T1), first metatarsal head (M1), and second metatarsal head (M2) were investigated in 13 healthy participants. One-way analysis of variance (ANOVA) showed that the effects of each insole inner pressure significantly differed (P < 0.05) with a 10 min walking duration. The PTI values resulting from 80 mmHg in M2 (38.4 ± 3.8, P = 0.002) and 160 mmHg in M1 (44.3 ± 4.3, P = 0.027) were lower than those from 240 mmHg. Additionally, the paired t test showed that the effects of each walking duration were also considerably different at 160 mmHg. The PTI at 10 min was lower than that at 20 min in M1 (44.31 ± 4.31, P = 0.015) and M2 (47.14 ± 5.27, P = 0.047). Thus, we suggest that walking with a pressure of 160 mmHg for 10 min has a lower risk of DFU.

The Antigravity Treadmill as a Postoperative and Injury Rehabilitation Tool: Reduction in Contact Forces and Muscle Activity With Reduced Weight Running.

To investigate the effects of reduced weight running on the antigravity (AG) treadmill on maintenance of normal muscle activation and reduction of plantar forces in healthy subjects. Descriptive laboratory study. Clinical sports medicine center. Twenty healthy subjects (10 male and 10 female) aged 18 to 29 years. Subjects running at 6.5 miles per hour on a standard treadmill and on the AG treadmill at 100%, 90%, 80%, 70%, 60%, and 50% of bodyweight levels. Dynamic plantar loading data were recorded using pressure insoles. Surface electromyography electrodes with imbedded accelerometers were used to estimate timing and magnitude of muscle activity, stride length, and cadence. There was a significant, sequential reduction in peak pressure, maximum force, and force time integral (FTI) with decreasing bodyweight. A 50% bodyweight reduction resulted in a 51% reduction in maximum force and a 59% reduction in FTI in the heel, as compared with 19% to 28% at the metatarsal heads. There was reduced contact area in the heel and midfoot at and below 70% BW. Lower limb muscle activity decreases with reduced bodyweight while maintain normal muscle recruitment timing. The AG treadmill provides a reduction in loading forces while maintaining normal muscle recruitment patterns. Decreased BW running preferentially unloads the hindfoot. The AG treadmill can be an effective rehabilitation tool following foot or ankle injury and may prove superior to other limited weight-bearing methods.

Preliminary Studies on Changes in Static Plantar Pressure and Stabilometry in Patients with Ankylosing Spondylitis Undergoing an Exercise Program.

Background/Objectives: Studies have reported that patients suffering from ankylosing spondylitis (AS) have decreased postural stability in comparison to healthy subjects. Our study aims to compare static plantar pressure and stabilometry parameters in AS patients who performed an 8-week exercise program (spine motion and flexibility exercises; stretching of hamstring, erector spine, and shoulder muscles; control abdominal and diaphragm breathing exercises and chest expansion exercises), in three different testing conditions (eyes open, eyes closed, and head retroflexed). Methods: Plantar pressure (the loading of the first and fifth metatarsal heads (MT1, MT5) and calcaneus) and stabilometry (CoP path length, 90% confidence ellipse area, and maximum CoP speed) were recorded in 28 AS patients (age 56.64 ± 10.3 years; body mass index 29.4 ± 4.9 kg/m2) at the beginning of rehabilitation and after 8 weeks. At first evaluation, there were significant differences (p < 0.05) for the foot loading sites (MT1, MT5, and calcaneus), both for the right and left feet, when comparing eyes open with the other two testing situations. Results: After rehabilitation, significant differences were recorded between eyes-open and head-retroflexed conditions for MT1 (p = 0.03 for right; p = 0.004 for left) and calcaneus (p = 0.014 for right; p = 0.011 for left). A significantly higher CoP path length was registered in both initial and final assessments when tested with eyes closed. The maximum CoP speed had increased values at both evaluations when tested with head retroflexed. Conclusions: The CoP path length decreased after the physical exercise program, with a better postural stability after rehabilitation.

Quantification of First Metatarsal Joint Surface Interactions in Hallux Rigidus Using Distance and Coverage Mapping: A Case-Control Study.

Weightbearing cone-beam computed tomography (WBCT) has proven useful for analysis of structural changes of the foot and ankle when compared to conventional radiographs. WBCT allows for extraction of distance and coverage mapping metrics, which may provide novel insight into hallux rigidus (HR). This study retrospectively assessed HR joint space using distance and coverage mapping in a case-control study. WBCT images of the foot and ankle for 20 symptomatic HR and 20 control patients were obtained. Three-dimensional models were created and analyzed using a custom semiautomatic measurement algorithm. Distance and coverage mapping metrics for the first metatarsophalangeal and metatarsosesamoid joints were extracted from the models and compared between cohorts. Relationships between these metrics and visual analog scale (VAS) scores, a patient-reported outcome of pain, were assessed in HR patients. Overall first metatarsophalangeal joint space narrowing was noted in HR patients when compared to controls by an average of 11.8% (P = .02). However, no significant changes in the overall coverage of the joint were noted. Decreased joint space width and increased surface-to-surface coverage were only and particularly observed at the plantar medial quadrant of the first metatarsal head in HR patients relative to controls. VAS score was significantly but weakly correlated with dorsolateral quadrant coverage (R2 = 0.26, P = .03). Distance and coverage mapping serve as a complementary option to current techniques of quantifying HR changes. These metrics can expand the scope of future work investigating joint articulation changes in HR.

The Effect of First Metatarsal Shortening and Sagittal Displacement on Forefoot Pressure in Minimally Invasive Hallux Valgus Correction.

Minimally invasive (MIS) treatment of hallux valgus (HV) deformity is increasing in popularity. A 2-mm diameter burr is used to create a distal first metatarsal osteotomy prior to capital fragment translation and fixation. The metatarsal will shorten by the burr's diameter (2 mm). Plantar or dorsal capital fragment displacement may also cause load transference and possibly transfer metatarsalgia. The purpose of this study is to examine the effect of MIS HV on forefoot loading mechanics with respect to metatarsal shortening and sagittal plane displacement. Four lower-limb cadaveric specimens were studied. A pedobarography pressure-sensing mat was used to record forefoot plantar pressure in a controlled weight-bearing stance position. Control and postosteotomy measurements were obtained with the capital fragment fixated in 3 possible positions: 0 mm, 5 mm dorsal, and 5 mm plantar displacement. Pedobarography data yielded pressure data within measurable graphical depictions. Raw mean contact pressure measurements were taken under the first and fourth metatarsal heads to establish medial and lateral forefoot loading pressure ratios. An a priori power analysis was performed based on previous peer-reviewed pedobarographic data, and our study was adequately powered. Around 40 measurements were recorded, and ratios of medial-to-lateral forefoot loading were constructed. Medial forefoot pressure control versus 0 mm displacement, and control versus dorsal displacement were not found to be statistically significant (p = 0.525, p = 0.55, respectively). Medial pressure significantly increased when comparing control versus plantar displacement (P = .006). Lateral pressure significantly increased with dorsal displacement of the osteotomy (P = .013). Our study found that MIS HV correction did not cause an increase in lateral forefoot pressure loading when sagittal plane displacements were controlled. Plantar displacement increased medial loading, and dorsal displacement increased lateral loading. It may be valuable for surgeons to consider metatarsal head position postosteotomy, as a decrease in medial loading and subsequent increase in lateral loading may lead to lateral forefoot pain and transfer metatarsalgia. IV.

Effectiveness of minimally invasive treatment of hallux valgus with small incision external articular osteotomy

To compare the effectiveness of small incision external articular minimally invasive osteotomy and traditional Chevron osteotomy in the treatment of hallux valgus. A retrospective analysis was conducted on the clinical data of 58 patients (58 feet) with hallux valgus who were admitted between April 2019 and June 2022 and met the selection criteria. Among them, 28 cases were treated with small incision external articular minimally invasive osteotomy (minimally invasive group), and 30 cases were treated with traditional Chevron osteotomy (traditional group). There was no significant difference in baseline data such as age, gender, disease duration, Mann classification, and preoperative inter metatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), forefoot width, tibial sesamoid position (TSP) score, American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score, visual analogue scale (VAS) score, psychological score (SF-12 MCS score) and physiological score (SF-12 PCS score) of short-form 12 health survey scale, and range of motion (ROM) of metatarsophalangeal joint between the two groups ( P>0.05). The incision length, operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, weight-bearing walking time, fracture healing time, and incidence of complications were recorded and compared between the two groups; as well as the changes of imaging indexes at last follow-up, and the clinical function score and ROM of metatarsophalangeal joint before operation, at 6 weeks after operation, and at last follow-up. All patients were followed up 11-31 months, with an average of 22 months. The incision length and intraoperative blood loss in the minimally invasive group were significantly less than those in the traditional group ( P<0.05), and the intraoperative fluoroscopy frequency and operation time in the minimally invasive group were significantly more than those in the traditional group ( P<0.05); but no significant difference was found in weight-bearing walking time and fracture healing time between the two groups ( P>0.05). There was 1 case of skin injury in the minimally invasive group and 3 cases of poor incision healing in the traditional group; all patients had good healing at the osteotomy site, and no complication such as infection, nerve injury, or metatarsal head necrosis occurred. At last follow-up, the imaging indexes of the two groups significantly improved when compared with those before operation ( P<0.05). The changes of DMAA and TSP score in the minimally invasive group were significantly better than those in the traditional group ( P<0.05), and there was no significant difference in the changes of IMA, HVA, and forefoot width between the two groups ( P>0.05). The clinical scores and ROM of metatarsophalangeal joint significantly improved in the two groups at 6 weeks after operation and at last follow-up when compared with preoperative ones ( P<0.05), and the indicators in the minimally invasive group were significantly better than those in the traditional group ( P<0.05). Compared with traditional Chevron osteotomy, small incision external articular minimally invasive osteotomy can effectively improve HVA, IMA, and forefoot width, correct foot deformities, and has less trauma. It can better correct the first metatarsal pronation deformity and restore the anatomical position of the sesamoid bone, resulting in better effectiveness.

Primary Isolated Arthrodesis of the First Metatarsophalangeal Joint for Hallux Rigidus: Clinical, Radiologic, and Pedobarographic Evaluation.

Arthrodesis of the first metatarsophalangeal joint is an effective treatment of advanced hallux rigidus. Numerous options have been described for performing this intervention. The aim of this study was to evaluate the outcomes following a consistent surgical technique of joint preparation with hand tools and fixation with 2 crossed screws and a dorsal compression plate. Thirteen patients (16 feet) who underwent primary isolated arthrodesis of the first metatarsophalangeal joint between March 2019 and June 2021 were available for clinical, radiologic, and pedobarographic evaluation at a minimum of 12 months after surgery. American Orthopaedic Foot & Ankle Society scores, numerical pain rating scale, the radiologic hallux valgus and intermetatarsal 1-2 angles as well as the distribution of plantar pressure during gait were compared between the pre- and postoperative conditions. After an average follow-up period of 26 months, union was achieved in all cases and the mean AOFAS score raised significantly by 39 points. All the patients were satisfied with the result. Only 1 patient complained of mild residual pain at walk. Hardware removal was performed in 2 cases. The mean hallux valgus angle dropped from 12.3 to 6.3 degrees. The mean postoperative dorsiflexion angle was 21.6 degrees. After the procedure, peak pressure was significantly higher beneath the first metatarsal head and heel, whereas pressure-time integral was significantly lower beneath the hallux and medial lesser toes. Arthrodesis of the first metatarsophalangeal joint with 2 crossed screws and a dorsal compression plate is a safe and effective treatment of advanced hallux rigidus. This procedure provides adequate pain relief and functional improvement of gait. Level IV, therapeutic, retrospective case series.

Spontaneous Reduction in the Intermetatarsal Angle in Distal First Metatarsal Osteotomies with No Lateral Head Displacement in Hallux Valgus.

The outcomes of first metatarsal (M1) distal osteotomies in hallux valgus (HV) can be improved, especially for intermetatarsal angle (IMA) correction, which is mainly based on lateral displacement of the M1 head (i.e., translation) through the osteotomy. Conversely, there is a spontaneous reduction in the IMA in first metatarsophalangeal joint (MTP1) arthrodesis. But we do not know whether this can be applied to distal osteotomies. We propose a distal osteotomy, called 3D chevron, which combines supination and varization of the M1 head. This might realign soft tissues around the MTP1, potentially leading to a spontaneous reduction in the IMA by an analogous mechanism to MTP1 fusion. Therefore, our study aimed to assess whether spontaneous reductions in IMAs exist in distal M1 osteotomies in the absence of lateral translations of M1 heads. A prospective continuous series of 25 3D chevrons was performed. Two groups were formed during surgery. Patients requiring no M1 head lateral displacement were included in the "successful correction without translation" group, and patients requiring M1 head lateral displacement were included in the "failed correction without translation" group. Radiographic analysis was performed preoperatively and at 1 year postoperatively. Twenty-two women and three men, with a mean age of 44.8 ± 14.2 years and a mean body mass index of 22.6 ± 4.1 kg/m2, underwent follow-up at one year after surgery. The "successful correction without translation" group was composed of HV with milder deformities (13/25 HVs, median preoperative IMA = 13 (IQR 2)) compared to the "failed correction without translation" group (median IMA = 16 (IQR 2.25) p < 0.001). Spontaneous reductions in IMAs were observed in the "successful correction without translation" group, with a median decrease in the IMA of 6 degrees (CI95%[5.5; 8.0]; p < 0.001) between preoperative and 1-year radiographs. Distal osteotomies allow for spontaneous reduction in the IMA in HV. First metatarsal head translation through an osteotomy should not be considered as the only procedure to correct IMAs in distal osteotomies.