Metatarsus Adductus Angle Research Articles

The Association of Metatarsus Adductus to the Proximal Fifth Metatarsal Jones Fracture

This retrospective study aimed to determine if a transverse plane forefoot relationship exists in patients with Jones fractures. Anteroposterior radiographs of 30 acute Jones fractures were compared with radiographs of 30 asymptomatic control subjects. Radiographic metatarsus adductus angle measurements were analyzed with a digital software program. The reliability of the measurements was evaluated with an intra-rater study. An independent t test was used to compare the metatarsus adductus angle between the Jones fracture group and the control group. Radiographic analysis revealed the mean metatarsus adductus angle for the Jones fracture group to be 20.22° (± 6.79°) compared with a mean of 14.27° (± 4.60°) for the control group. This difference between the groups was found to be statistically significant (p < .005). The intraclass reliability coefficient (ICC = 0.9396) confirmed there was no bias in the radiographic measurements. The metatarsus adductus angle in this group of patients with Jones fractures was increased compared with the nonpathologic control group. The Jones fracture mechanism of injury and resultant lateral column overload may be intensified with an increased metatarsus adductus. This relationship should be considered a risk factor for Jones fractures and taken into consideration with respect to bone healing, treatment, and prevention.

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.

Reliability of metatarsus adductus angle and correlation with hallux valgus

Metatarsus adductus is a common congenital foot deformity. Variable prevalence values were reported using different techniques in different populations. Numerous radiological measurements have been proposed to assess this deformity with a paucity of studies reporting the reliability of these methods. The metatarsus adductus angle was shown to correlate with the severity of hallux abductovalgus in normal feet and preselected populations of juvenile hallux valgus. Weight bearing dorsoplantar radiographs of 150 feet were examined for 5 angles commonly used in assessing metatarsus adductus: angle between the second metatarsus and the longitudinal axis of the lesser tarsus (using the 4th or 5th metatarso-cuboid joint as a reference), Engel's angle and modified Engle's angle. The prevalence of metatarsus adductus was assessed according to published criteria for different techniques. Inter and intra-observer reliabilities of these angles were evaluated on 50 X-rays. Linear regression tests were used to assess the correlation between hallux valgus and different angles used in assessing metatarsus adductus. Intraclass correlation coefficients were high for intra- as well as inter-observer reliability for the 5 angles tested. Prevalence of metatarsus adductus ranged (45-70%) depending on the angle used in the same population. Only the metatarsus adductus angle using the 4th metatarso-cuboid joint as a reference demonstrated significant correlation between metatarsus adductus and hallux abductovalgus angles. Five techniques commonly used in assessing metatarsus adductus demonstrated high inter and intra-observer reliability values. Prevalence of metatarsus adductus and the correlation between the severity of this deformity and hallux valgus angle is sensitive to the assessment method.

Correlation of Harris Mats, Physical Exam, Pictures, and Radiographic Measurements in Adult Flatfoot Deformity

In many reports describing flatfoot deformities, the abnormality is described using observations from physical examination, radiographs, or foot imprints. Correlation of these measurements is often lacking, making determination of the magnitude of the deformity or its surgical correction difficult to quantify. Weightbearing AP and lateral radiographs were obtained on 25 patients (39 feet) with a clinically apparent flatfoot deformity and an asymptomatic control group of 28 subjects (56 feet). Radiographs were examined for the lateral talometatarsal angle, the lateral talocalcaneal angle, calcaneal pitch, first metatarsocuneiform height, medial cuneiform -fifth metatarsal height, metatarsus primus elevatus, plantar gapping at the first metatarsocuneiform joint, the AP talonavicular coverage angle, and the metatarsus adductus angle. Harris mat imprints were obtained on each foot and measured for the magnitude of the flatfoot deformity. Physical examination included the subjective appearance to the examiner of the degree of pes planus (none, mild, moderate, severe), hindfoot valgus, and ankle range of motion. Photographs of the hindfoot were obtained in a standardized manner, and hindfoot valgus was measured from these photos and compared to the measured hindfoot valgus on the physical exam. Statistically significant differences between the two groups were found in the lateral talometatarsal angle, lateral talocalcaneal angle, calcaneal pitch, first metatarsocuneiform height, the AP talonavicular coverage angle, Harris mat imprint score, subjective pes planus score, hindfoot valgus measurement from both photographs and physical examination, ankle range of motion (all with a p value less than 0.01), and the metatarsus adductus angle (p = 0.019). No patient in the control group and 14 (36%) in the flatfoot group had evidence of plantar gapping at the first metatarsocuneiform joint. In the flatfoot group, statistically significant correlations were demonstrated between the Harris mat score and heel valgus as measured by photographic and physical examination, subjective pes planus grading by physical exam, the lateral talometatarsal angle, and the first metatarsocuneiform height. This study validates the use of the Harris mat imprint as an effective method of quantifying the magnitude of a flatfoot deformity. We also found a statistically significant decrease in ankle range of motion in the flatfoot group, indicating that tightness of the gastrocsoleus complex is part of the pathophysiology of flatfoot deformity.

Metatarsus Adductus Angle in Male and Female Feet

The literature contains several techniques for calculating metatarsal adductus angle. Most common systems use the fourth metatarsal cuboid joint and the fifth metatarsal cuboid joint. Although both systems are quite different, normal values of metatarsus adductus angle have not been established with each system of measurement. Two hundred six radiographic images of feet in dorsoplantar projection were used to measure the metatarsus adductus angle using two different reference points: the joint between the fourth metatarsal and the cuboid and the joint between the fifth metatarsal and the cuboid. Comparison of the results of the two measurement techniques showed significant differences (P < .05). The values of the metatarsus adductus angle also showed significant differences in men versus women (P < .05). The reliability of the measurements was checked by using an intra- and inter-evaluator test performed by two evaluators. Data showed the reliability of both systems of measurement, although significant differences in the metatarsal adductus angle mean value were found using these systems of measurement in the same foot. On the other hand, significant differences were found in mean values of metatarsus adductus angle between male and female feet.

A radiographic study of the relationship between metatarsus adductus and hallux valgus

The relationship between metatarsus adductus and hallux valgus was evaluated on 100 dorsoplantar weight-bearing radiographs. The metatarsus adductus angle varied positively with the degree of hallux valgus. By using measures of correlation, a significant linear association was found for women (r = .53, P < .001) and men (r = .48, P < .001). The relationship was strongest in women when all cases of abnormal metatarsus adductus (>24°) were associated with abnormal degrees of hallux valgus (>15°). This relationship was different in men in that abnormal metatarsus adductus angles were not always associated with abnormal hallux valgus angles. With male and female data combined, the prevalence of metatarsus adductus was 55% in subjects with hallux valgus deformity compared with 19% in subjects without hallux valgus. A X 2 test showed this to be a significant difference in the distribution of the data (P = .002). The data of this study suggests that there may be a clinical association between metatarsus adductus and hallux valgus. The need to further evaluate the role of metatarsus adductus angle in hallux valgus surgery is emphasized. (The Journal of Foot & Ankle Surgery 42(1):9-14, 2003)

Juvenile hallux abducto valgus association with metatarsus adductus

The authors evaluated the radiographs of 40 patients (72 feet) under 21 years of age who underwent surgery for symptomatic hallux abducto valgus deformity at Northlake Regional Medical Center. Forty-eight of 72 feet had metatarsus adductus angles greater than 15 degrees. A statistically significant correlation was found between an increasing metatarsus adductus angle and an increasing hallux abductus angle.

Characteristics of adolescent hallux abducto valgus. A retrospective review.

The authors review 63 surgical cases of adolescent hallux abducto valgus in 54 patients from the Foot and Ankle Institute of the Pennsylvania College of Podiatric Medicine over a 7-year period. Twenty-five closing base wedge and capital osteotomies were evaluated for radiographic changes. Three quarters of a group of 65 patients with adolescent hallux abducto valgus were found to have an abnormally high metatarsus adductus angle. Patients who had a closing base wedge osteotomy had higher preoperative radiographic angles for the intermetatarsal, metatarsus adductus, hallux abductus, and proximal articular set angles as well as the tibial sesamoid position. Those patients had 4.49 degrees more intermetatarsal angle correction than the patients who had a capital osteotomy. Implications for evaluation and treatment are discussed.

A method of correcting metatarsus primus varus; preliminary report.

The Journal of Bone and Joint Surgery. British volumeVol. 33-B, No. 3 Clinical Reviews and StudiesFree AccessA METHOD OF CORRECTING METATARSUS PRIMUS VARUSV. H. EllisV. H. EllisSearch for more papers by this authorPublished Online:1 Aug 1951https://doi.org/10.1302/0301-620X.33B3.415AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited ByIntra and Inter-Observer Reliability and Repeatability of Metatarsus Adductus Angle in Recreational Football Players: A Concordance Study6 April 2022 | Journal of Clinical Medicine, Vol. 11, No. 7Temporary Screw Lateral Hemiepiphysiodesis of the First Metatarsal for Juvenile Hallux Valgus Deformity: A Case Series of 23 FeetThe Journal of Foot and Ankle Surgery, Vol. 61, No. 1Clinical historical aspects of treatment of (part I)N.N. Priorov Journal of Traumatology and Orthopedics, No. 2Analysis of Serial Radiographs of the Foot to Determine Normative Values for the Growth of the First Metatarsal to Guide Hemiepiphysiodesis for Immature Hallux ValgusJournal of Pediatric Orthopaedics, Vol. 37, No. 5Geometry of the Proximal Phalanx of Hallux and First Metatarsal Bone to Predict Hallux Abducto Valgus: A Radiological Study18 November 2016 | PLOS ONE, Vol. 11, No. 11Pediatric First Ray DeformitiesClinics in Podiatric Medicine and Surgery, Vol. 30, No. 4EVALUATION OF METATARSAL RELATIONSHIPS IN THE BIOMECHANICS OF 332 NORMAL FEET USING THE METHOD OF MEASURING RELATIVE LENGTHSRevista Brasileira de Ortopedia (English Edition), Vol. 46, No. 4Treatment of Hallux Valgus with Increased Distal Metatarsal Articular Angle: Use of Double and Triple OsteotomiesFoot and Ankle Clinics, Vol. 14, No. 3Disorders of the FootJuvenile Hallux Valgus DeformityJournal of Pediatric Orthopaedics, Vol. 27, No. 7First Cuneiform Osteotomy Alters Hindfoot ArchitectureClinical Orthopaedics and Related Research, Vol. 441, No. &amp;NA;Bunion Correction Using Proximal Chevron Osteotomy: A Single-Incision Technique28 June 2016 | Foot & Ankle International, Vol. 19, No. 7Juvenile Hallux Valgus: Etiology and Treatment28 June 2016 | Foot & Ankle International, Vol. 16, No. 11Applications of the opening wedge cuneiform osteotomy in the surgical repair of juvenile hallux abducto valgusThe Journal of Foot and Ankle Surgery, Vol. 34, No. 2Radiographic analysis of hallux valgus. A two-dimensional coordinate system.The Journal of Bone & Joint Surgery, Vol. 77, No. 2The X-ray measurement of hallux valgus: an inter- and intra-observer error studyThe Foot, Vol. 2, No. 1Correction of Hallux Valgus and Metatarsus Primus Varus Using the Cedell TechniqueOrthopedics, Vol. 12, No. 3Surgery for Adolescent Hallux Valgus8 July 2009 | Acta Orthopaedica Scandinavica, Vol. 45, No. 1-4Hallux Valgus in Adolescents1 September 2016 | Proceedings of the Royal Society of Medicine, Vol. 51, No. 11 Vol. 33-B, No. 3 Metrics Downloaded 729 times History Published online 1 August 1951 Published in print 1 August 1951 InformationCopyright © 1951, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download