Metatarsal Protrusion Distance Research Articles

Minimally Invasive Chevron Akin (MICA) Osteotomy Corrects Radiographic Parameters but Not Central Metatarsal Loading in Moderate to Severe Hallux Valgus without Metatarsalgia.

Central metatarsal pressure is increased in patients with hallux valgus, but the pedographic outcomes after hallux valgus (HV) correction are inconclusive. No known literature has reported the pedographic outcomes after HV correction with Minimally Invasive Chevron and Akin Osteotomy (MICA). A prospective cohort of 31 feet from 25 patients with moderate-to-severe symptomatic HV but without metatarsalgia underwent MICA and was evaluated using radiographic parameters and pedographic measurements (Footscan®, RSscan International, Olen, Belgium). Data were collected preoperatively and 3 months after surgery. The radiographic parameters of the hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, first metatarsal head lateral shape, and lateral sesamoid grade significantly improved after MICA. The corrected first metatarsal length was significantly shortened by 2.3 mm, with consistent second metatarsal protrusion distance, lateral Meary's angle, and calcaneal pitch angle. Max force, max pressure, cumulative force, and cumulative pressure on the central metatarsals did not show significant changes between pre- and post-operative measurements, while these parameters significantly decreased in the hallux and first metatarsal area. MICA effectively corrects radiographic parameters but does not reduce central metatarsal loading in patients with moderate-to-severe HV without metatarsalgia.

Correction effects of peroneus longus contraction on hallux valgus radiographic parameters

BackgroundHypermobility of the first tarsometatarsal joint plays an important role in hallux valgus pathogenesis. The peroneus longus is recognized as a dynamic stabilizer of the first tarsometatarsal joint. However, the association between the peroneus longus function and the hallux valgus deformity remains unknown. This study aimed to determine the effect of peroneus longus contraction induced by electrical muscle stimulation on the correction of hallux valgus radiographic parameters in patients with hallux valgus. MethodsThirty-five patients with hallux valgus (47 feet; 2 men, 33 women; mean age 64.9 years) were included. Non-weight-bearing dorsoplantar radiographs of the foot were obtained with and without electrical muscle stimulation of the peroneus longus. Radiographic parameters of hallux valgus deformities, including the hallux valgus angle, intermetatarsal angle, first metatarsal protrusion distance, and distance between the first and second metatarsal bases, were measured and compared between the two conditions. ResultsAll hallux valgus radiographic parameters were significantly improved by contraction of the peroneus longus. The median hallux valgus angle decreased by 13.2°. Fewer changes in the hallux valgus angle were identified in patients with severe deformity and geriatric patients. ConclusionsAlthough the peroneus longus muscle has received little attention in the management of hallux valgus, our findings suggest that it has the potential to be a novel conservative approach for treating mild-to-moderate hallux valgus.

Correlation between first tarsometatarsal joint sagittal mobility and hallux valgus combined with transfer metatarsalgia

Objective: To investigate the correlation between the first tarsometatarsal joint (TMT1) sagittal mobility and hallux valgus (HV) combined with transfer metatarsalgia (TM). Methods: The weight-bearing CT (WBCT) imaging data of 111 HV patients (167 feet) who were treated at the Foot and Ankle Surgery Center, Beijing Tongren Hospital Affiliated to Capital Medical University from January 2018 to January 2020 were retrospectively analyzed. The patients underwent PedCAT WBCT scans of both feet, and the hallux valgus angle (HVA), intermetatarsal angle (IMA), plantar distance (PD), medial cuneiform-first metatarsal angle (CMA) and metatarsal protrusion distance (MPD) were measured using CubeVue software. PD and CMA were signs of TMT1 instability. Visual analogue scale (VAS) and foot and ankle ability measures (FAAM) scores were obtained. The patients were divided into TM group and non-TM group according to the presence of metatarsalgia. The TM group and the non-TM group were compared in terms of HVA, IMA, PD, CMA, MPD, VAS and FAAM. Correlations between PD, CMA and HVA, IMA, VAS, FAAM were analyzed using Spearman correlation. Results: Total of 111 cases were included in this study, there were 35 males and 76 females with a mean age of (57.7±14.1) years. The average values of HVA (37.9°±8.6°), IMA (17.9°±2.6°), CMA (2.1°±0.3°) and PD [(1.8±0.4) mm] in TM group were all significantly higher than those in the non-TM group [HVA (32.5°±9.1°), IMA (15.1°±3.4°), CMA (1.7°±0.3°) and PD (1.6±0.2) mm] (All P<0.001). There was no significant difference in MPD between the two groups (P=0.580). The TM group demonstrated a higher VAS score when compared with the non-TM group (P<0.001). The FAAM score of the TM group (54.1±11.8) was significantly lower than that in the non-TM group (66.2±11.4) (P<0.001). The results of Spearman correlation analysis showed that there was no correlation between PD and HVA, IMA and VAS score. There was a negative correlation between PD, CMA and FAAM score, and the difference was statistically significant (rs=-0.637, -0.254, both P<0.001); CMA was positively correlated with HVA, IMA, and VAS score (rs=0.603, 0.971, 0.269, all P<0.001). Conclusions: WBCT is helpful for the diagnosis of TMT1 sagittal instability. The severity of TMT1 sagittal instability is positively correlated with hallux valgus and TM. The TMT1 instability may play an important role in the pathogenesis of hallux valgus.

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.

Identification of radiographic characteristics associated with pain in hallux valgus patients: A preliminary machine learning study.

ObjectiveTo investigate the association between the structural deformity and foot pain in hallux valgus (HV) patients using a multi-variate pattern analysis (MVPA) approach.MethodsPlain radiographic metrics were calculated from 36 painful and 36 pain-free HV feet. In analysis 1, univariate analyses were performed to investigate the clinical and radiographic differences between painful and pain-free HV. In analysis 2, we investigated the pattern differences for radiographic metrics between these two groups using a MVPA approach utilizing a support vector machine. In analysis 3, sequential backward selection and exhaustive search were performed as a feature-selection procedure to identify an optimal feature subtype. In analysis 4, hierarchical clustering analysis was used to identify the optimal radiographic HV subtype associated with pain in HV.ResultsWe found that: (1) relative to feet with pain-free HV, the painful ones exhibited a higher hallux valgus angle, i.e., the magnitude of distal metatarsal and phalangeal deviation; (2) painful HV could be accurately differentiated from pain-free HV via MVPA. Using sequential backward selection and exhaustive search, a 5-feature subset was identified with optimal performance for classifying HV as either painful or pain-free; and (3) by applying hierarchical clustering analysis, a radiographic subtype with an 80% pain incidence was identified.ConclusionThe pain in HV is multifactorial and associated with a radiographic pattern measured by various angles on plain radiographs. The combination of hallux valgus angle, inter-phalangeal angle, distal metatarsal articular angle, metatarsal cuneiform angle and metatarsal protrusion distance showed the optimal classification performance between painful and pain-free HV.

Metatarsal Protrusion Distance and Its Influence on Recurrent Ulceration Rates After Partial First-Ray Amputations: A Retrospective Study

Recurrent ulceration is a common problem after partial first-ray amputations. Loss of the first metatarsophalangeal joint contributes to altered biomechanics and increased pressure on the foot. This may increase risk of adjacent ulcerations and additional amputations. Preserving first-ray length maintains the metatarsal parabola and limits transfer lesions, but few data support this. We aimed to evaluate the incidence of ulceration after partial first-ray amputations and to assess the association between metatarsal protrusion distance and recurrent ulceration. Thirty-two consecutive patients underwent unilateral partial first-ray amputation at various levels along the first metatarsal, and the metatarsal protrusion distance was measured after surgery. Incidence of ulceration was evaluated on the ipsilateral foot. We hypothesized that patients with a longer first metatarsal were less likely to ulcerate again on the ipsilateral foot. Fourteen patients (43.8%) ulcerated again after partial first-ray amputation. Mean time to ulceration was 104 days. Active smoking status was associated with increased risk of another ulceration (P = .02), and chronic kidney disease was associated with a decreased risk of recurrent ulceration (P = .03). The average metatarsal protrusion distance for patients who ulcerated again after surgery was 36.1 mm versus 25.9 mm for patients who did not (P = .04). Logistic regression analysis of the receiver operating characteristic curve demonstrated an ideal cutoff length for recurrent ulceration of 37 mm (area under the curve = 0.7381). Patients with a protrusion distance greater than 37 mm were nine times as likely to ulcerate again (95% CI, 1.7-47.0). Partial first-ray amputations can be a good initial salvage procedure to clear infection and prolong bipedal ambulatory status. Unfortunately, these patients are prone to recurrent ulceration. Significant loss of first metatarsal length is a poor prognostic indicator for recurrent ulceration.

Triplanar Chevron Osteotomy: A Newly Proposed Method to Treat Hallux Valgus Deformities.

ObjectiveTo present a novel method called triplanar chevron osteotomy to treat hallux valgus (HV).MethodsThis is a retrospective study. In this study, the CT data of HV patients with painful callosities were evaluated retrospectively between 1 June 2018 and 1 June 2020. CT data from 49 consecutive patients (59 feet) with HV were evaluated. The average age at the time of surgery was 49.6 years (range, 30–63 years). The apex of the chevron osteotomy procedure was located at the center of the first metatarsal and was defined as the line formed by the central point perpendicular to the fourth metatarsal bone. The cut planes of the plantarward oblique chevron osteotomy (POCO) were defined as follows: chevron osteotomy along with 20° of plantarward obliquity. The triplanar osteotomy incision was made using the POCO method, with the direction inclined by 10° distally. The intermetatarsal angle (IMA), the HV angle (HVA), the projection of the second metatarsal (PSM), the metatarsal protrusion index (MPI), and the metatarsal protrusion distance (MPD) were all calculated before and after the operations. The length of the first metatarsal was measured and calculated with an equation.ResultsThe results showed that the HVA was significantly decreased after surgery (32.7° ± 4.6° vs 14.9° ± 2.1°, t = 25.583, P < 0.001) in the triplanar, traditional, and POCO groups. The IMA was also significantly decreased (14.7° ± 2.0°) compared with the results before surgery (8.0° ± 1.1°, t = 22.739, P < 0.001) in these groups. Compared with traditional osteotomy and POCO, there were no differences in correcting deformities on axial planes for the HVA (14.5° ± 1.7° vs 14.9° ± 2.1°, t = 1.835, P = 0.072) and IMA (8.1° ± 1.1° vs 8.0° ± 1.1°, t = −0.97, P = 0.336). There was a statistically significant decrease following surgery in terms of the PSM, MPI, and MPD after triplanar osteotomy. The length of the first metatarsal increased (10.9 ± 1.3 mm), as measured through three‐dimensional images in the triplanar osteotomy group. The length was calculated as follows: H = L2 * Tan θ ≈ L/COS β * Tan θ.ConclusionThe new triplanar osteotomy technique is safe and effective for treating HV, and in simulation experiments reveals potential benefits of correction and preventing transfer metatarsalgia.

Anatomical Risk Factors Associated with Rapid Progression of Hallux Valgus Deformity

Category:Bunion; OtherIntroduction/Purpose:Hallux valgus (HV) deformity generally progresses gradually over the long term. However, the deformity progresses rapidly in some patients. Information on the future progression of the deformity helps treatment decision-making of both surgeons and patients. However, few studies have reported the natural progression of HV deformity. The purposes of this study were to clarify 1) the incidence and 2) anatomical risk factors of the rapid progression of HV deformity.Methods:Patients who visited the foot and ankle clinic of our hospital between 2013 and 2019 were retrospectively analyzed. Inclusion criteria were patients who underwent repeated foot radiographs with an interval of >=2 years. Exclusion criteria were patients <18 years old, history of first ray surgery, deformity or destruction of the first metatarsal head, and unable to stand plantigrade. The increase in HV angle between the baseline and the last follow-up was calculated. Then, patients were dichotomized into two groups: those with an increase in HV angle >=5°(Group P) and those with an increase of <5°(Group S). Radiographic measurements, including HV angle, Hardy’s sesamoid position, distal metatarsal articular angle, rounded metatarsal head, first metatarsal protrusion distance, were performed on the dorsoplantar and lateral foot radiographs at the baseline. The association between the baseline radiographic measurements and progression of HV deformity was assessed using the univariate and multivariate analyses.Results:A total of 268 feet of 268 patients (217 women and 51 men, mean age 61 years) were analyzed. The mean HV angle was 28°, and the mean interval between radiography was 49 months. Forty-five (17%) and 223 (83%) feet were categorized into groups P and S, respectively. The baseline Hardy’s sesamoid position was independently associated with the future progression of the deformity: 6/115 (5%) feet with normal sesamoid (grade <4) were in group P. On the other hand, 39/183 (21%) feet with laterally deviated sesamoid (grade>=4), 39 were in group P (p<0.001). The HV angle at baseline was not associated with the deformity progression (p=0.09). Other measurements, such as rounded metatarsal head, were also not associated with the progression.Conclusion:The rapid progression of HV deformity occurred in 1 out of 6 patients. Furthermore, the lateral deviation of the sesamoid on the dorsoplantar radiograph of the foot may be the risk factor of the rapid progression. For patients with mild deformity but deviated sesamoid, early corrective surgery may be justified to prevent the rapid progression of HV deformity.

Outcome of Second-Ray Pathologies Following Weil Osteotomy in Patients Treated for Hallux Valgus.

Background: We hypothesized that the cause of second-ray pathology with hallux valgus is excessive relative length of the second metatarsal and performed Weil osteotomy to shorten it, with correction of hallux valgus. The purpose of this study is to evaluate the outcome of second-ray pathology after distal chevron osteotomy (DCO) with Weil osteotomy to correct metatarsal parabola. Methods: We performed concomitant Weil osteotomy of the second metatarsal with DCO of the first metatarsal as part of hallux valgus with second-ray pathology correction surgery in 45 feet (40 patients). Second-ray pathologies were claw toe deformity, painful plantar callosity, second metatarsophalangeal joint (MTPJ) dislocation, and osteoarthritis (OA) of the second MTPJ. We measured projection of the second metatarsal (PSM), metatarsal protrusion index (MPI), and metatarsal protrusion distance (MPD). The second-ray surgery outcome was assessed by patient satisfaction. Results: Patient satisfaction was good in claw toe deformity and OA (satisfaction rate: 60% [23 patients] and 71% [7 patients], respectively) and fair in painful plantar callosity and second MTP joint dislocation (satisfaction rate: 44% [9 patients] and 33% [6 patients], respectively). Total patient satisfaction rate was higher when the PSM, MPI, and MPD ranged between 7 and 12 mm, -5 and 0 mm, and 0 and 4 mm, respectively. Conclusions: We concluded that simultaneous performance of hallux valgus correction and Weil osteotomy in patients with second-ray pathologies associated with hallux valgus was safe as well as effective. Correcting the metatarsal parabola within the appropriate range after surgery is associated with second-ray pathology outcome. Levels of Evidence: Therapeutic studies, Level VI: Case series.

An Imaged-Based Three-Dimensional Study of First Metatarsal Protrusion Distance in Women with and Without Hallux Valgus.

First metatarsal protrusion distance (MPD) has been commonly studied as a characteristic of hallux valgus deformity. To date, the majority of investigations have used radiographic methods, with most reporting first metatarsal (ray) protrusion to be associated with deformity. As an alternative, this study used a three-dimensional (3-D) image acquisition and data analysis method to quantify MPD. Magnetic resonance images were acquired in weightbearing on 29 women (19 with hallux valgus; 10 controls). After the 3-D images were reconstructed into virtual bone models, two examiners measured MPD in relation to the navicular. In addition to a reliability analysis, a t test assessed for group differences in demographics, foot posture (hallux valgus, intermetatarsal angles), and MPD. Group demographics were not different, while measures of hallux valgus and intermetatarsal angles were different ( P < 0.01) between groups. The measurement of MPD was highly reliable (ICC [Formula: see text] 0.99; SEM [Formula: see text] 0.78 mm). Metatarsal protrusion averaged approximately -2.0 mm in both groups. There was no statistical group difference ( P = 0.89) in MPD. The reconstructed image datasets captured the 3-D spatial relationship of the anatomy. Measurements of MPD were reliable. The first ray measured 2 mm shorter than the second ray in both the hallux valgus and control groups. Though unexpected, this result may prompt future study of the pathokinematics associated with hallux valgus that include the quantification of metatarsal protrusion with 3-D methods, instead of relying solely on single-plane radiograph reports.

Joint Preserving Procedure for Moderate Hallux Rigidus: Does the Metatarsal Index Really Matter?

Surgical treatment of moderate hallux rigidus remains controversial and the optimal surgical technique has yet to be defined. Decompressive metatarsal osteotomy is one of the procedures available; however, one of the potential drawbacks is the effect of the metatarsal shortening. We evaluated the global effect of the decompressive metatarsal osteotomy, accounting for the metatarsal index. We retrospectively evaluated 78 patients with stage II and III hallux rigidus who had undergone Youngswick osteotomy and analyzed their outcomes according to the metatarsal index. The candidates for inclusion underwent clinical and radiographic evaluation, including the visual analog scale foot and ankle score, first metatarsophalangeal joint range of motion, and first metatarsal protrusion distance to define the metatarsal index. Also, shortening of the first metatarsal was measured postoperatively, and the occurrence of metatarsalgia was considered a postoperative complication. The mean follow-up period was 53±17months. The groups stratified according to the metatarsal index (index plus, index plus minus, and index minus) presented with similar results (p > .05). The average preoperative visual analog scale foot and ankle score of 56.4±13.8 points improved significantly to 84.1±5.5 points postoperatively (p<.0001). Also, the mean preoperative dorsiflexion of 20.4°±1.5° improved to 37.3°±1.6° postoperatively (p<.0001). Of the 78 patients, 97% would recommend the procedure to a family member or friend. Four patients (6%) experienced postoperative metatarsal pain. We found consistent results with this procedure. The reported functional score and dorsiflexion improvement provide evidence that good outcomes and high levels of patient satisfaction can be achieved, regardless of the metatarsal length.

Radiographic Measurements of the Affected and Unaffected Feet in Patients with Unilateral Hallux Limitus A Case-Control Pilot Study.

Controversy exists regarding the structural and functional causes of hallux limitus, including metatarsus primus elevatus, a long first metatarsal, first-ray hypermobility, the shape of the first metatarsal head, and the presence of hallux interphalangeus. Some articles have reported on the radiographic evaluation of these measurements in feet affected by hallux limitus, but no study has directly compared the affected and unaffected feet in patients with unilateral hallux limitus. This case-control pilot study aimed to establish whether any such differences exist. Dorsoplantar and lateral weightbearing radiographs of both feet in 30 patients with unilateral hallux limitus were assessed for grade of disease, lateral intermetatarsal angle, metatarsal protrusion distance, plantar gapping at the first metatarsocuneiform joint, metatarsal head shape, and hallux abductus interphalangeus angle. Data analysis was performed using a statistical software program. Mean radiographic measurements for affected and unaffected feet demonstrated that metatarsus primus elevatus, a short first metatarsal, first-ray hypermobility, a flat metatarsal head shape, and hallux interphalangeus were prevalent in both feet. There was no statistically significant difference between feet for any of the radiographic parameters measured (Mann-Whitney U tests, independent-samples t tests, and Pearson χ(2) tests: P > .05). No significant differences exist in the presence of the structural risk factors examined between affected and unaffected feet in patients with unilateral hallux limitus. The influence of other intrinsic factors, including footedness and family history, should be investigated further.

Intra-observer reliability for measuring first and second toe and metatarsal protrusion distance using palpation-based tests: a test-retest study

Intra-observer reliability for measuring first and second toe and metatarsal protrusion distance using palpation-based tests: a test-retest study

Intra-observer reliability for measuring first and second toe and metatarsal protrusion distance using palpation-based tests: a test-retest study.

BackgroundMeasurement of first and second metatarsal and toe protrusion is frequently used to explain foot problems using x-rays, osteological measurements or palpation-based tests. Length differences could be related to the appearance of problems in the foot. A test-retest design was conducted in order to establish the intra-rater reliability of three palpation-based tests.Methods202 feet of physical therapy students and teachers of the CEU San Pablo University of Madrid, 39 men and 62 women, were measured using three different tests. Data were analysed using SPSS version 15.0. Mean, SD and 95% CI were calculated for each variable. A normal distribution of quantitative data was assessed using the Kolmogorov-Smirnov test. The test-retest intra-rater reliability was assessed using an Intraclass Correlation Coefficient (ICC). The Standard Error Mean (SEM) and the Minimal Detectable Change (MDC) were also obtained.ResultsAll the ICC values showed a high degree of reliability (Test 1 = 0.97, Test 2 = 0.86 and Test 3 = 0.88) as did the SEM (Test 1 = 0.07, Test 2 = 0.10 and Test 3 = 0.11) and the MDC (Test 1 = 0.21, Test 2 = 0.30 and Test 3 = 0.31).ConclusionsReliability of measuring first and second metatarsal and toe protrusion using the three palpation-based tests showed a high degree of reliability.

The Underlying Osseous Deformity in Plantar Plate Tears

Plantar plate tears can cause pain and deformity of the forefoot. The purpose of this study is to correlate common radiographic findings with observed intra-operative pathology in patients with plantar plate pathology. Bilateral weight-bearing radiographs were reviewed for 88 patients (106 feet) who underwent surgical repair of suspected plantar plate pathology. Parameters reviewed included the first intermetatarsal angle, the metatarsus adductus angle, the second and third metatarsophalangeal angles, splaying of the second and third toes, evaluation of the metatarsal parabola by 3 different methods, the first and second lateral declination angles, and the second lateral metatarsophalangeal angle. Of 106 feet, 97 had intra-operative plantar plate tears. The radiographs of patients with plantar plate tears had an increased amount of digital splay on the anteroposterior radiograph compared to patients without pathology. For patients with unilateral plantar plate pathology, the metatarsal parabola of the symptomatic foot was compared with that of the asymptomatic foot. A significantly increased second metatarsal protrusion distance as measured by 2 different methods was noted in the symptomatic foot. Odds ratios revealed that patients with an intermetatarsal angle >12, medial deviation of the second toe, and splaying of the digits were more likely to be diagnosed with a plantar plate tear intra-operatively. Although radiographs do not definitively diagnose plantar plate tears, understanding osseous forefoot architecture will aid with diagnosis in the absence of other osseous pathology. Furthermore, these data suggest that parabola should be corrected to maintain long-term correction of plantar plate pathology. Prognostic, Level II.

Reliability and Relationship of Radiographic Measurements in Hallux Valgus

Although various radiographic measurements have been developed and used for evaluating hallux valgus, not all are universally believed to be necessary and their relationships have not been clearly established. Determining which are related could provide some insight into which might be useful and which would not. We investigated the reliability of eight radiographic measurements used to evaluate hallux valgus, and determined which were correlated and which predicted the hallux valgus angle. We determined eight radiographic indices for 732 patients (mean age, 51 years; SD, 17 years; 107 males and 625 females) with hallux valgus: hallux valgus angle, intermetatarsal angle, hallux interphalangeal angle, distal metatarsal articular angle, proximal phalangeal articular angle, simplified metatarsus adductus angle, first metatarsal protrusion distance, and sesamoid rotation angle. Intraobserver and interobserver reliabilities of each radiographic measurement were analyzed on 36 feet from 36 randomly selected patients. Correlations among the radiographic measurements were analyzed. Radiographic measurements predicting hallux valgus angle were evaluated using multiple regression analysis. Hallux valgus angle had the highest reliability, whereas the distal metatarsal articular angle and simplified metatarsus adductus angle had the lowest. Distal metatarsal articular angle, intermetatarsal angle, and sesamoid rotation angle had the highest correlations with hallux valgus angle. Distal metatarsal articular angle correlated with sesamoid rotation angle. The intermetatarsal angle, interphalangeal angle, distal metatarsal articular angle, first metatarsal protrusion distance, sesamoid rotation angle, and metatarsus adductus angle predicted the hallux valgus angle. We suggest using hallux valgus angle, intermetatarsal angle, interphalangeal angle, sesamoid rotation angle, and first metatarsal protrusion distance considering their reliability and prediction of the deformity.

Inverted Z-scarf Osteotomy for Hallux Valgus Deformity Correction: Intermediate-term Results in 55 Patients

The Z-scarf osteotomy is used for hallux valgus deformity correction by foot and ankle surgeons worldwide. Inverting the Z-scarf osteotomy configuration strengthens the construct in both sawbone and cadaver models, but clinical results of this configuration have not been reported in the literature. This retrospective study evaluates the subjective and intermediate-term postoperative radiographic results of 73 inverted Z-scarf osteotomy procedures for hallux valgus correction in 55 patients from January 1994 to December 2003. The modified University of Maryland 100-Point Painful Foot Center Scoring System demonstrated 52 patients (95%) with good to excellent results at a mean follow-up of 5 years (range 2–11 years). Radiograph measurements revealed the following: first-second intermetatarsal angle mean, 6.1° (range 2–14°), average reduction 4.6°; hallux abductus angle mean, 11.0° (range –8–30°), average reduction 10.1°; tibial sesamoid position mean, 2.3; first metatarsal protrusion distance mean, –2.1 mm. Two patients (2 of 73 feet) developed major complications: one progressed to clinically acceptable hallux varus; another sustained compromise of one fixation screw with minor displacement at the distal osteotomy that healed in satisfactory position after non–weight-bearing immobilization. There were no cases of osteonecrosis, delayed union, or nonunion. The inverted Z-scarf osteotomy, with advantages in both mechanical strength and technique of execution over the traditional configuration, demonstrates high patient satisfaction, restoration of normal radiographic parameters, and a low complication rate in this study.

Correction of Metatarsus Primus Varus with an Opening Wedge Plate: A Review of 18 Procedures

The opening base wedge osteotomy is a safe and useful surgical alternative for correction of moderate to severe hallux valgus deformities with substantial metatarsus primus varus. The authors combine the modified McBride bunionectomy with a proximal first metatarsal opening base wedge osteotomy. Osteotomy stabilization was achieved without bone grafting with a titanium fixation plate specifically designed for opening proximal osteotomies. To assess outcomes achieved by the use of this fixation device, we reviewed the records of 18 procedures (16 patients). Preoperative and postoperative weight-bearing radiographs were measured to compare changes in the following radiographic variables: intermetatarsal angle 1-2, hallux valgus angle, the first metatarsal protrusion distance, and the Seiberg Index. The mean follow-up duration was 11 months (range, 6-17 months). The median intermetatarsal angle decreased by 9 degrees (range, 2 degrees-15 degrees), the hallux valgus angle decreased by 13.5 degrees (range, 0 degrees-56 degrees), and the change in first metatarsal protrusion distance was +2.6 mm (range, -0.8 to 6.6 mm), and all of these changes were statistically significant (P < or = .001). The preoperative to postoperative change in the Seiberg Index was not statistically significant (P = .17). In regard to the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal score, the postoperative scores were statistically significantly higher than the preoperative scores (P < .001). Complications included 2 (11.11%) recurrences, and 1 (5.56%) case of deep vein thrombosis. Fourteen patients (16/18 feet, 88.89%) reported satisfaction with the surgical results. 4.

Radiographic Measurements of Patients With Juvenile Hallux Valgus Compared With Age-Matched Controls: A Cohort Investigation

The purpose of this study was to investigate radiographic measurements in a cohort of patients with juvenile hallux valgus (with a hallux valgus angle > 15 degrees ) using standardized weightbearing x-rays compared with an age-matched control group. First metatarsal protrusion distance, metatarsus primus adductus angle, metatarsus adductus, first metatarsal cuneiform angle, calcaneal inclination angle, and talocalcaneal angles were assessed with discriminant functional analysis. A total of 37 sets of data were analyzed from patients with a mean age of 13.45 +/- 1.75 years. The study identified 2 significant components of juvenile hallux valgus: a positive first metatarsal protrusion distance (P <.001) and metatarsal primus adductus angle (P = .002). Discriminant functional analysis was then used to determine the best predictors of juvenile hallux valgus. This analysis allowed only 1 variable, metatarsal protrusion distance, as a predictor of whether juvenile hallux valgus was present (P < .001), with 94.3% accuracy. This study showed that a positive metatarsal protrusion distance is a significant component of juvenile hallux valgus.

Plantar Pressure and Radiographic Changes to the Forefoot After the Austin Bunionectomy

We describe the effects of the Austin bunionectomy on plantar pressure distribution and radiographic measurements in the forefoot in 31 subjects (44 feet) with mild-to-moderate hallux valgus deformity and 36 control subjects (36 feet). Plantar pressure measurements before and 24 months after surgery showed peak pressure beneath the hallux reduced to normal values. Peak pressure measurements beneath the first, second, and third metatarsal heads in hallux valgus feet were relatively unchanged after surgery and remained higher than normal values. The operation produced significant decreases in mean preoperative radiographic measurements of hallux abductus, metatarsus primus varus, and first metatarsal protrusion distance in these patients to below-normal values.